Site Seeing in O&P

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By Erin Cammarata
Erin Cammarata

The challenging compliance environment in which the O&P profession operates presents many situations that may cause you to second guess the accuracy of your compliance processes. At CBS, we often get phone calls from people with questions about coding, billing, and Medicare regulations. As we help our clients with these questions, we reference the sources we use and direct our clients to these sources. In this article, I share some of the website-based tools we use.

  1. Documentation Checklist
    Noridian Healthcare Solutions, the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for Region D, has documentation checklists on its website. These checklists should be used to help ensure that your Medicare claims have all the required documentation and should become part of your internal chart audit. You can also use these checklists as a learning tool for your practitioners and/or administrative staff. On the Noridian website, you will find documentation checklists for most of the O&P categories your office is servicing. To access the checklists, visit med.noridianmedicare.com/web/jddme/policies/documentationchecklists.
  2. Appeals Filing Deadlines
    CGS Administrators is the DME MAC for Region C. Its website offers an Appeals Timeliness Calculator to help you determine the filing deadline for all five levels of the appeals process. We recommend submitting your appeal as soon as you get the notice from Medicare. But in the event your practice is unable to respond immediately, we recommend using this calculator to determine the date by which all the paperwork is required, creating an action plan on how to obtain the paperwork, and to ensure you meet those deadlines. To access the calculator, visit www.cgsmedicare.com/medicare_dynamic/j15/hhh_time_limit_calculator.asp.
  3. Accreditation
    We often get calls for accreditation help. These calls come from new and well-established facilities. The American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) and the Board of Certification/Accreditation (BOC) have resources on their websites to help you keep up with your practice's specific reaccreditation requirements or prepare for a new accreditation. It is best to implement the resources into your practice on a continuous basis so you remain abreast of the regulations and standards.
       ABC has an annual accreditation task planner. This is your annual to-do list to maintain your facility's ABC accreditation. To access this tool, visit www.abcop.org/facility-accreditation/patientcare/Pages/maintaining.aspx. BOC offers an accreditation guide that includes videos, a standards guide, and site survey checklists so you can stay on track with your facility's BOC accreditation. To access this tool, visit www.bocusa.org/survivalguide.
  4. Medicare Internet-Only Manuals
    As a billing company, we use many of Medicare's resources. One of our go-to sources is the library of Medicare's Internet- Only Manuals (IOMs), which can be found on the Centers for Medicare & Medicaid Services (CMS) website. These manuals are Medicare's day-to-day operating instructions and policies. There are many useful IOMs but one of our favorites is the Medicare Benefit Policy Manual. This manual gets used on a regular basis not only to direct our clients but also when we are fighting an audit or appealing a claim. For example, Chapter 15, 20.3 - Artificial Limbs, Braces, and Other Custom Made Items Ordered But Not Furnished outlines how and when to bill for a custom item if the patient dies or the order was cancelled.
       To access the list of all Medicare IOMs, visit www.cms.gov/regulations-and-guidance/guidance/manuals/internet-only-manuals-ioms.html.
       These resources are only some of the tools that we use on a regular basis in our practice. I strongly recommend that you also research your third-party payers and examine their websites, sign up for any web portals they offer, and use their web-based tools to create a resource library for your practice.

Erin Cammarata is president and owner of CBS Medical Billing and Consulting, Hampton Falls, New Hampshire. She can be reached at .