reimbursement issues...
Phil Meyers, CO
Description
Collection
Title:
reimbursement issues...
Creator:
Phil Meyers, CO
Text:
It is a constant effort to code appropriately for the services we render and
for the orthoses (and prostheses) we fabricate and deliver. Is it just me,
or do we all feel that the L-code system is antiquated in it's terminology
and almost forces fraud and abuse because proper representation of the
products does not exist! This is a hot topic for me and a cause for great
consternation almost daily. Our company strives to code properly, using
every code that is appropriate and dropping any that fall into the great
chasm of ambiguity. I have always felt uneasy about billing out a neoprene
knee sleeve with (...polycentric hinges...) for hundreds of dollars when the
same item resides at retail outlets for $50. Of course, I understand my role
in all of this and how we are not a retail outlet blah, blah blah... The
problem is that we now have more than one physician sending patients over
with a photocopied page from the Alimed book (prices right there for all to
see) and then the patient receives a bill for often 1000% more than the book
price. Bill out a Freedom thermo-molded thumb spica sometime and you'll see
a great example of what I'm talking about. Our cost=$33.00 Our
reimbursement using the closest code for this item (and, by the way,
recommended by Alimed)=$300+.
Needless to say the doctor freaked out (patient was his son) but I have
little recourse as I can't just use any old L-code just because the perceived
reimbusement is a little more in line... I did write a letter explaining in
great detail the shortcomings of our billing system but this is just one of
many many examples I have. Does anyone have any thoughts as to how to make
changes on a national level so that practicing ethically and honestly doesn't
make us look like the bad guys!
Sincerely,
Phil Meyers, CO
for the orthoses (and prostheses) we fabricate and deliver. Is it just me,
or do we all feel that the L-code system is antiquated in it's terminology
and almost forces fraud and abuse because proper representation of the
products does not exist! This is a hot topic for me and a cause for great
consternation almost daily. Our company strives to code properly, using
every code that is appropriate and dropping any that fall into the great
chasm of ambiguity. I have always felt uneasy about billing out a neoprene
knee sleeve with (...polycentric hinges...) for hundreds of dollars when the
same item resides at retail outlets for $50. Of course, I understand my role
in all of this and how we are not a retail outlet blah, blah blah... The
problem is that we now have more than one physician sending patients over
with a photocopied page from the Alimed book (prices right there for all to
see) and then the patient receives a bill for often 1000% more than the book
price. Bill out a Freedom thermo-molded thumb spica sometime and you'll see
a great example of what I'm talking about. Our cost=$33.00 Our
reimbursement using the closest code for this item (and, by the way,
recommended by Alimed)=$300+.
Needless to say the doctor freaked out (patient was his son) but I have
little recourse as I can't just use any old L-code just because the perceived
reimbusement is a little more in line... I did write a letter explaining in
great detail the shortcomings of our billing system but this is just one of
many many examples I have. Does anyone have any thoughts as to how to make
changes on a national level so that practicing ethically and honestly doesn't
make us look like the bad guys!
Sincerely,
Phil Meyers, CO
Citation
Phil Meyers, CO, “reimbursement issues...,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/214247.
