HOW TO AVOID AND PREVENT MEDICAL BILLING
ERRORS IN PEDORTHICS
Another major element in most billing strategies is to utilize modern,
sophisticated practice management, billing, and digital records
systems.
to beneficiaries. There is also a standard for maintaining visible
licenses and credentials at a place of business.
However, although DMEPOS provides a framework of sorts for
industry compliance, professionals in the pedorthics industry
who have attended multiple Medicare-sponsored seminars
may have walked away with less understanding about how
to comply with Medicare’s policies because it seems to be
interpreted differently, depending on the seminar. Additional
problems, according to industry experts, relate to using CERT
or Comprehensive Error Rate Testing contractors to evaluate
compliance. Multiple types of audits can contradict each
other compounding confusion for specialists and the referring
physician. This can result in a huge burden for a practice with
reimbursement delays, costs associated with additional labor or
resource reallocation. Delivering quality patient care is first and
foremost but understanding how to get paid or even keeping
your reimbursement on that care can certainly be baffling. The
fact that DME items are ‘ancillary’ to services is part of what is
driving this industry-wide concern over what may be appropriate
for any given provider. The Pedorthic Footcare Association, a
key industry group, also contends that many errors in various
audits stem from issues with documentation submitted by
a provider - or lack thereof. Valuable and important details
include date of order, physician signature, record date in
addition to other items that may be required such as test reports
and physician records.
Strategies for Combating Billing Confusion
Although a raft of regulations and contractual details can
confuse practice leadership and diminish revenue or cause
serious financial problems within an office, there are ways that
you can address and prevent these situations. One of these
involves careful analysis of your practice billing cycle over time.
Work back to when denials and rejections started to occur.
Collecting more data and developing a ‘bird’s eye view’ of your
office operations over a longer period of time can often provide
invaluable insight for improvement areas.
Another major element in most billing strategies is to utilize
modern, sophisticated practice management, billing, and digital
records systems. Top tier systems automate many functions and
will provide continuous compliance updates. Evaluate systems
by how they meet your unique environment challenges rather
than fitting the technology to your practice. By using your
technology effectively, you will receive relief from nearly any
of the problems mentioned above. This allows you to place
more of your practice’s resources to patient care, marketing your
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Pedorthic Footcare Association www.pedorthics.org
expertise, and customer service.
Understanding Medicare’s National or Local Area Coverage
Determination policies can also shrink errors. This is the
backbone of recognizing the special requirements and
documentation that must be met in order to be reimbursed for
the services in specific limited circumstances such as found
in the pedorthics field. Solid detailed documentation from
all relevant care party providers is crucial because without
proof of medical necessity, delay and non-payment will occur.
Encourage collaboration and communication because this will
greatly assist you during the claims submission process.
Many of the top payers and clearinghouses also offer real-time
online insurance eligibility tools. Aside from verifying coverage,
request clarification on exclusions, special restrictions, carve-out
updates, and certification prerequisites. Building a partnership
with your payers also makes sense. By taking the time to
properly verify eligibility up front, you will avoid one less giant
headache on the back end.
Putting it All Together
The key to this kind of efficiency is to hire legitimate,
professional and competent medical billing professionals or
contract with a third party medical billing service that can
furnish the right kinds of tools and resources for your practice.
This means having leadership in active dialogue with the
folks responsible for your billing and coding, asking the right
questions and setting up a range of efficient solutions that
will help to perfect a revenue cycle rather than sow seeds of
confusion and consequential delays.
In an industry with a lot of moving targets, where criteria and
standards are transitioning from dynamic to fixed so there
is less interpretation, staying on top of change can also be
facilitated with ongoing training and education. It’s important
for practice leaders to stay engaged and brainstorm ways to
protect your livelihood against many of the problems that have
plagued others in the pedorthics industry, where even small
documentation problems can disrupt the operations of the
business and threaten its financial solvency. With a little top-
down planning and consistent action, a pedorthics business can
go a long way toward setting the stage for many successful years
of future operation.