What every O & P practitioner must know to survive!
As president of a full service billing company “Complete Professional Office Services” with 30 years of experience in the O & P Industry, I understand the dilemma of companies trying to navigate this constantly changing profession on a daily basis. You could read magazines or trade journal articles, but these usually address our profession’s problems after the damage is done. This blog is designed to make you aware of changes that are happening in real time so you can take immediate action on them. I’m trying with this blog to get your head up. If you decide to use your own billing department, to get and keep legitimately earned money, you need to react immediately . You (the owner) must take sole responsibility for investigation, interpretation, and the interoffice structure to adapt efficiently to the changes to the O & P insurance claims process.
What should we expect to see coming for you and me in our industry?
You as a facility owner, are entering into a new business environment. Medicare has started many new innovative investigation procedures that are cutting down your payments and are experiencing success in doing so. Judging from this, expect that this trend will continue, and if you don’ t take action you will be getting paid less and less for your hard work. Medicare is also constantly making new rules and changes to maintain cost containment and to stop fraud. They are doing this by increasing surveillance of RAC’S (The Recovery Audit Contractor (or RAC) program is an aggressive tool used by the federal government to seek out potential fraud and abuse in Medicare billing). Another area to watch out for is “take back” consequences to payments with inadequate documentation after the changes were implemented using DRG’s (The DRG system is a per-case reimbursement mechanism under which inpatient admission cases are divided into relatively homogeneous categories called diagnosis-related groups called DRGs). In O&O these two systems have had over a 71% take back rate on all investigated items for Medicare
What affect will Obama Care (The Affordable Care Act) have on O & P?
first a large increase in the number of covered persons is going to increase our business base.
Due to the Affordable Care Act, Medicaid and private insurance’s “coverage, and customer numbers” are increasing dramatically. To protect themselves private insurance is following Medicare’s lead using the same cost cutting changes. They are implementing innovative surveillance tactics and requiring pre-authorization. You as a practice owner must understand and react immediately before these negatively impact present and future business costs.
What can you do today?
Follow this blog, we can help you stay informed and help you keep your hard earned dollars in your pocket so that you can continue to help your patients live better lives through your work!
This blog covers what CPO Services does for you automatically at the same cost or less. With out all that managment. When you decide to compare call. Our policy is first call answer your questions. I call back after you have had a week to go over what makes it work, co-ordination between offices, reports special software placed at your desposal, how we get information from you, inter office encryption, HIPPA requirments, appeals paperwork servaillance and much more. this is not a sales call we believe you must be informed to make your decision, it’s a large commitment and we respect it as such. If nothing else I know you will enjoy learnging what arcutitecture is necessary for a truely efficient billing department.
How the frequency of Medicare changes will affect you on DRG’s!!