Tuesday, January 31, 2023
OANDP-L
  • Login
No Result
View All Result
The O&P EDGE
  • PECOS
  • Magazine
    • Subscription
    • Current Issue
    • Issue Archive
    • News Archive
    • Product & Service Directory
    • Advertising Information
  • O&P Jobs
    • Find a Job
    • Post a Job
  • EDGE Advantage
  • O&P Facilities
  • Resources
    • Product & Service Directory
    • Calendar
    • Contact
    • About Us
    • O&P Library
    • The Guide
    • Custom Publications
    • Advertising Information
    • EDGE Direct
    • Amplitude Media Group
  • PECOS
  • Magazine
    • Subscription
    • Current Issue
    • Issue Archive
    • News Archive
    • Product & Service Directory
    • Advertising Information
  • O&P Jobs
    • Find a Job
    • Post a Job
  • EDGE Advantage
  • O&P Facilities
  • Resources
    • Product & Service Directory
    • Calendar
    • Contact
    • About Us
    • O&P Library
    • The Guide
    • Custom Publications
    • Advertising Information
    • EDGE Direct
    • Amplitude Media Group
No Result
View All Result
The O&P EDGE Magazine
No Result
View All Result
Home On Topic

Billing Company Secrets (Ssshhhh!)

by Erin Cammarata
September 1, 2018
in On Topic
0
SHARES
6
VIEWS
Share on FacebookShare on Twitter

 

In our years in business handling over 100,000 O&P claims per year in 22 states, CBS Medical Billing and Consulting has acquired some important resources and strategies that help us successfully navigate the insurance and reimbursement maze. I will share a few that we find invaluable that you can add to your list.

 

On a daily basis, our O&P billers use many Medicare web pages. Medicare web pages are not limited to the local coverage determinations (LCDs), which anyone in O&P should already have downloaded to their desktops. For example, a unique feature on the Noridian website under Education and Outreach is the Tools section (https://med.noridianmedicare.com/web/jddme/education/calculators-tools).

You will find tools including:

  • Appeals Decision Tree to help you determine if a claim can be appealed.
  • Documentation Checklists created to help suppliers ensure all necessary documentation is ready and on file.
  • Appeals Calculator to identify submission deadlines.
  • Medically Unlikely Edit (MUE) Lookup, a new interactive tool that helps you determine the allowed quantity for Healthcare Common Procedure Coding System (HCPCS) codes.

Other useful online resources we utilize are online insurance policy and procedure manuals. Just like Medicare, most insurance carriers have their policy manuals available on the web. The manuals contain information from item-specific coverage policy to billing guidelines. Knowing the policies and procedures for all your carriers is essential when it comes to reimbursement.

 

Let’s use the example of a 16-year-old patient with an Aetna plan who needs a new microprocessor knee.

 

Upon verification of benefits, you receive generic information such as “covered if meets medical necessity,” but what does Aetna consider to be medically necessary? This is where the policy comes in.

By reading the policy, you will find out that the payer will consider a microprocessor if the patient is a healthy, active community ambulator over 18 years old.

Without reviewing Aetna’s complete policy, you may have delivered a prosthesis that would not been covered (www.aetna.com/cpb/medical/data/500_ 599/0578.html).

Here’s a great CBS secret. Are you tired of phone trees and ridiculously long wait times to get a live person on the phone to ask a simple question? We found an online tool called GetHuman (www.gethuman.com) that provides current wait times along with a phone number or keys to press to speak to a live agent. It also identifies the best times to call to speak to a representative faster and often has the equivalent of a Rolodex with phone numbers to call for various departments. It’s not perfect, but it does save time.

If you find yourself speaking with an insurance representative who is in another country and you are having a difficult time understanding them or being understood by them, you can request to speak to an on-shore agent. There is currently a bill in Congress that would require U.S. companies with call centers outside the country to transfer a call to an agent in the United States upon request. But even without it, we have never been denied a request to speak to an on-shore agent.

Subscribe

Gain unlimited access to every O&P EDGE article ever published, more than 15 years of archived editorial content
Subscribe Now

Related posts:

  1. Clarifying Medicare Participation and Assignment Rules, Part Two
  2. The RACs Are Coming: Preparing for Medicare Claims Denials of O&P Care
  3. Healthcare Policy: Where It Comes From and How to Change It
  4. Healthcare Policy: Where It Comes From And How To Change It
Tags: On Topic
Previous Post

Standing Requires Increased Cognitive Control for Lower-limb Amputees

Next Post

OPERF Recognizes Ten Years of Award Winners

Next Post

OPERF Recognizes Ten Years of Award Winners

  • VIEW CURRENT ISSUE
  • SUBSCRIBE FOR FREE

RECENT NEWS

News

CMS Adds to Orthosis Face-to-Face and Written Order Prior to Delivery List

by The O&P EDGE
January 24, 2023

The Centers for Medicare & Medicaid Services (CMS) announced the addition of ten orthoses codes that will require a face-to-face...

Read more

Corrected Dates for PrimeFare Central

Kenney Orthopedics Joins Limb Loss & Preservation Registry

Prosthesis Type Affects Quality of Life

Get unlimited access!

Join EDGE ADVANTAGE and unlock The O&P EDGE's vast library of archived content.
SUBSCRIBE TODAY

O&P JOBS

Central

Certified Prosthetist/Orthotists

Central

Part-Time Prosthetic Practitioner in Oklahoma

Central

ABC Certified Orthotist /Prosthetist II

 

© 2021 The O&P EDGE

  • About
  • Advertise
  • Contact
  • EDGE Advantage
  • OANDP-L
  • Subscribe

CONTACT US

866-613-0257

[email protected]

201 E. 4th St
Loveland, CO 80537

The most important industry news and events delivered directly to your inbox every week.

No Result
View All Result
  • PECOS
  • MAGAZINE
    • SUBSCRIBE
    • CURRENT ISSUE
    • ISSUE ARCHIVE
    • NEWS ARCHIVE
    • PRODUCTS & SERVICES DIRECTORY
    • ADVERTISING INFORMATION
  • O&P JOBS
    • FIND A JOB
    • POST A JOB
  • EDGE ADVANTAGE
  • FACILITES
  • RESOURCES
    • PRODUCTS & SERVICES DIRECTORY
    • CALENDAR
    • CONTACT
    • ABOUT US
    • O&P LIBRARY
    • THE GUIDE
    • CUSTOM PUBLICATIONS
    • ADVERTISING
    • EDGE DIRECT
    • AMPLITUDE
  • OANDP-L
  • LOGIN

© 2021The O&P EDGE

Welcome Back!

Login to your account below

Forgotten Password?

Retrieve your password

Please enter your username or email address to reset your password.

Log In
The O&P EDGE Magazine
 
Required 'Candidate' login to applying this job. Click here to logout And try again
 

Login to your account

  • Forgot Password? | Sign Up

Reset Password

  • Already have an account? Login

Enter the username or e-mail you used in your profile. A password reset link will be sent to you by email.

Signup to your Account

  • By clicking checkbox, you agree to our Terms and Conditions and Privacy Policy

    Already have an account? Login

Close
Are you sure want to unlock this post?
Unlock left : 0
Are you sure want to cancel subscription?
 

Account Activation

Before you can login, you must activate your account with the code sent to your email address. If you did not receive this email, please check your junk/spam folder. Click here to resend the activation email. If you entered an incorrect email address, you will need to re-register with the correct email address.