Trying Times

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By Erin Cammarata
Erin Cammarata

Hello everyone, I'm the president and owner of CBS Medical Billing and Consulting, Hampton Falls, New Hampshire. I have been professionally involved in O&P for the past 23 years.

I'm a self-proclaimed "Medicare enthusiast," meaning that I enthusiastically keep current on almost everything that is Medicare related and have developed strategies to help my clients succeed despite Medicare rules, documentation requirements, audits, and the lengthy appeals process. My accumulated experience and expertise in O&P billing has resulted in developing practical and effective strategies that are critical to the success of O&P practices.

This is the first of many articles I'll be writing for The O&P EDGE and it is an honor to be selected to bring you bimonthly information that is "on topic." This month's topic is "Trying Times."

In the past few months, I've been to seven O&P professional meetings, sometimes as a presenter. Almost everyone wants to discuss Medicare regulations and related audits. For example, participants routinely express common concerns such as: "My referring physicians do not know what needs to be included in their documentation." "My referring physicians don't have the documentation that Medicare is requesting." "I am lucky if I receive a prescription for the patient's device." "A five-year reasonable useful life for an AFO is unreasonable," and "I have been waiting three years for my Administrative Law Judge hearing."

While these concerns are valid and understandable, it is time that we accept that this is the new landscape that we face; complaining will not affect the consequences. Similar to the way familiar landscapes change after an earthquake and make our homes and businesses more difficult to live in, Medicare has changed our business terrain. Most people don't just lament and accept defeat after an earthquake; rather, they rally and rebuild. If we want to stay in practice, we need to adapt to our new landscape-we need to rally, rebuild, restructure, and redesign our practices.

The first thing we need to do is assess our risks. What are your top risk areas?

After assessing more than 30 practices around the country, these are some of the areas I have found in which practices need improvement:

  1. Consistently producing compliant O&P practitioner clinical notes.
  2. Obtaining corroborating physician documentation.
  3. Establishing effective management processes and instilling practicewide accountability (i.e. putting an end to charts being passed from person to person without anyone addressing problems contained within them).
  4. Ensuring that all billing/administrative staff and practitioners know the local coverage determinations (LCDs).

How can we make these changes?

  1. Set up regular office meetings with practitioners and administrative staff to discuss the topics above as well as any others you identify.
  2. Read and discuss the LCDs as a group. Create user-friendly tools for the clinical and administrative team (i.e. cheat sheets of the LCDs, tools to remind practitioners of what they need to have in their documentation, and form letters requesting documentation to send to referring physicians).
  3. Enfranchise everyone; get them involved by auditing each other's patient charts.
  4. When employees prove themselves to be unchangeable or processes are ineffective, make the changes necessary to not only become compliant but also to be the best at it.
  5. Be proactive and complete your own prepayment audits. Correct any errors prior to billing.

These are dynamic times complete with evolving challenges that will separate the nimble from the inflexible practices. A wise man once said, "It's not the smartest nor the strongest who will survive in today's tumultuous business climate. It will be the most adaptable."

Erin Cammarata is president and owner of CBS Medical Billing and Consulting, Hampton Falls, New Hampshire. While every attempt has been made to ensure accuracy, The O&P EDGE is not responsible for errors. For more information, contact .