Orthotic care reimbursements RESPONSES
Randy McFarland
Description
Collection
Title:
Orthotic care reimbursements RESPONSES
Creator:
Randy McFarland
Date:
8/16/2006
Text:
ORIGINAL POST
Has your O&P facility ceased providing certain services like compression
hose, corsets, foot orthoses, shoes and shoe modifications? How have you
dealt with reimbursement challenges for off the shelf items?
Anonymous responses will be posted back to the List without reference
to specific fees. Randy McFarland, CPO Fullerton, CA
RESPONSES
Instead of discontinuing these services I decided to go the cash route.
Especially in cases where the insurance company will not pay or will not
pay
me because I'm off contract. In most cases the patients have paid
without
complaint and the cash flow is useful. In addition when a patient has
more
than one need like an AFO and compression hose or shoes the one stop
concept
appeals to the patient even if they are paying for that additional
service.
In most cases price wise we use a standard retail mark up instead of
insurance pricing especially for off the shelf items. As far as certain
OTS
items like knee sleeves etc. I've been fairly successful in finding
quality
products at a lower price than most O&P distributors which allows me to
compete on some level with the doctors, surgical supply and drug stores.
I've stop trying to out do certain larger companies.
I have not completely stopped all I still do shoes, inserts, and
modifications but only for a limited number of referral sources. I have
completely stopped doing compression garments as the reimbursement is
marginal at best, but mainly because of quality and service from
compression mfg. companies. We try to provide continuation of care for
our existing patients and this sometimes means little or no profit. Some
compression garment manufacturers (Medi, Juzo, etc.) that are European
are priced way above my reimbursement level so I am forced to use a
domestic source which is very inferior and has poor customer service.
I cannot and will not take a loss for an item. I think that for anyone
to expect that I should purchase a product and provide it to them at a
loss is way out in left field. I think we in the O&P industry should not
be treated any differently than any other retail business. Not as a
Welfare or Entitlement program. I tell the patients up front that I'm
sorry but I can't provide that type of service anymore and the reason.
So far most are understanding.
That's all we do because the MD offices do everything else and they
don't want to mess with the Piddly stuff...even the Podiatrists are
doing shoes and then sending them to us for modifications.
We only provide stockings, shoe mods, elevations, corsets and binders on
a cash basis at U&C.
Diabetic footwear we provide but the shoes are our selection. If the
patient wants the high-end shoes, PW Minor, Drew, etc. They are
responsible.
We address our contracts for off the shelf items a little differently
also. All our contracts are generic as the L codes are function based.
If a physician, patient or anyone else demands the brand name they can
pay for it - otherwise we provide a functional equivalent item. Most
people seem to understand this concept.
WE stopped providing those items and arch supports as well.
We have stopped providing compression hose to outpatients. We will
provide them to local hospitals, when we are paid by purchase order. The
main reason for this decision was lack of insurance coverage and
reimbursement.
In our analysis, we were losing money on those items, so we hooked up
with a
local medical supply facility that provides these items and began to
refer
everything to them. We told the local referral sources that they had
longer
hours and many brands of the same item to choose from. They were also
open
on Saturday, so why fight it? This way, the doctors know to send all of
the
custom items to us and the ots items to someone who is not a competitor
for
the custom items. There is a COF at the store, so ethically, I am ok.
They
have an understanding that if it is too complex, they can refer them to
us
for a custom item. As a result, we have had additional time to address
new
referral sources, we aren't rushed for time on the prostheses, and I
haven't
seen a dip in revenue.
While we still offer some of these services, we are certainly changing
how we provide them. I can remember having three different corset lines
( straight waist, curvy waist etc) is all the 2' increment sizes. Today
unfortunately it's got to be s,m ,l with velcro closures. With the
reimbursement and ADMIN time you cannot justify spending as much time
with the patient on these off the shelf items as you have in the past.
Patients still occasionally come in to get some of these items, after
you make a chart, measure, fit and explain donning, doffing and care,
they decide that they don't want them.
In my mind we have to continue to try and distinguish ourselves as
clinicians; our time and judgment is what we have to offer. Widgets can
be bought at the drug store.
Admin time on these claims is another killer. We are currently
trying to determine a policy/procedure where on small claims ( under
$250 or so) the patient has more responsibility to get the records,
clinicals etc, that the insurance companies are requiring. Any
input/suggestions from others would be greatly appreciated.
I am not now practicing O&P, but I think I can speak for many
orthotists on
this issue. Here's why: Last September we (HOPE Orthopedic) introduced
our
LumboLux(TM) orthosis, which is essentially an elastic corset with front
and
rear pockets for polymer inserts. You can get paid for the LumboLux!
And, for
the last year, we've consistently had ads saying so.
I cannot tell you how many orthotists have told me, David, you're
about a year too late for me. I stopped fitting corsets because that
service was a loser. Now I wouldn't know how to get
that business back. If I had to guess, Randy, I'd say I've heard some
variation of that about 100 times!
I'm one person. Think of how many orthotists have actually given up
corsets
if I've heard that from 100 of them!
Has your O&P facility ceased providing certain services like compression
hose, corsets, foot orthoses, shoes and shoe modifications? How have you
dealt with reimbursement challenges for off the shelf items?
Anonymous responses will be posted back to the List without reference
to specific fees. Randy McFarland, CPO Fullerton, CA
RESPONSES
Instead of discontinuing these services I decided to go the cash route.
Especially in cases where the insurance company will not pay or will not
pay
me because I'm off contract. In most cases the patients have paid
without
complaint and the cash flow is useful. In addition when a patient has
more
than one need like an AFO and compression hose or shoes the one stop
concept
appeals to the patient even if they are paying for that additional
service.
In most cases price wise we use a standard retail mark up instead of
insurance pricing especially for off the shelf items. As far as certain
OTS
items like knee sleeves etc. I've been fairly successful in finding
quality
products at a lower price than most O&P distributors which allows me to
compete on some level with the doctors, surgical supply and drug stores.
I've stop trying to out do certain larger companies.
I have not completely stopped all I still do shoes, inserts, and
modifications but only for a limited number of referral sources. I have
completely stopped doing compression garments as the reimbursement is
marginal at best, but mainly because of quality and service from
compression mfg. companies. We try to provide continuation of care for
our existing patients and this sometimes means little or no profit. Some
compression garment manufacturers (Medi, Juzo, etc.) that are European
are priced way above my reimbursement level so I am forced to use a
domestic source which is very inferior and has poor customer service.
I cannot and will not take a loss for an item. I think that for anyone
to expect that I should purchase a product and provide it to them at a
loss is way out in left field. I think we in the O&P industry should not
be treated any differently than any other retail business. Not as a
Welfare or Entitlement program. I tell the patients up front that I'm
sorry but I can't provide that type of service anymore and the reason.
So far most are understanding.
That's all we do because the MD offices do everything else and they
don't want to mess with the Piddly stuff...even the Podiatrists are
doing shoes and then sending them to us for modifications.
We only provide stockings, shoe mods, elevations, corsets and binders on
a cash basis at U&C.
Diabetic footwear we provide but the shoes are our selection. If the
patient wants the high-end shoes, PW Minor, Drew, etc. They are
responsible.
We address our contracts for off the shelf items a little differently
also. All our contracts are generic as the L codes are function based.
If a physician, patient or anyone else demands the brand name they can
pay for it - otherwise we provide a functional equivalent item. Most
people seem to understand this concept.
WE stopped providing those items and arch supports as well.
We have stopped providing compression hose to outpatients. We will
provide them to local hospitals, when we are paid by purchase order. The
main reason for this decision was lack of insurance coverage and
reimbursement.
In our analysis, we were losing money on those items, so we hooked up
with a
local medical supply facility that provides these items and began to
refer
everything to them. We told the local referral sources that they had
longer
hours and many brands of the same item to choose from. They were also
open
on Saturday, so why fight it? This way, the doctors know to send all of
the
custom items to us and the ots items to someone who is not a competitor
for
the custom items. There is a COF at the store, so ethically, I am ok.
They
have an understanding that if it is too complex, they can refer them to
us
for a custom item. As a result, we have had additional time to address
new
referral sources, we aren't rushed for time on the prostheses, and I
haven't
seen a dip in revenue.
While we still offer some of these services, we are certainly changing
how we provide them. I can remember having three different corset lines
( straight waist, curvy waist etc) is all the 2' increment sizes. Today
unfortunately it's got to be s,m ,l with velcro closures. With the
reimbursement and ADMIN time you cannot justify spending as much time
with the patient on these off the shelf items as you have in the past.
Patients still occasionally come in to get some of these items, after
you make a chart, measure, fit and explain donning, doffing and care,
they decide that they don't want them.
In my mind we have to continue to try and distinguish ourselves as
clinicians; our time and judgment is what we have to offer. Widgets can
be bought at the drug store.
Admin time on these claims is another killer. We are currently
trying to determine a policy/procedure where on small claims ( under
$250 or so) the patient has more responsibility to get the records,
clinicals etc, that the insurance companies are requiring. Any
input/suggestions from others would be greatly appreciated.
I am not now practicing O&P, but I think I can speak for many
orthotists on
this issue. Here's why: Last September we (HOPE Orthopedic) introduced
our
LumboLux(TM) orthosis, which is essentially an elastic corset with front
and
rear pockets for polymer inserts. You can get paid for the LumboLux!
And, for
the last year, we've consistently had ads saying so.
I cannot tell you how many orthotists have told me, David, you're
about a year too late for me. I stopped fitting corsets because that
service was a loser. Now I wouldn't know how to get
that business back. If I had to guess, Randy, I'd say I've heard some
variation of that about 100 times!
I'm one person. Think of how many orthotists have actually given up
corsets
if I've heard that from 100 of them!
Citation
Randy McFarland, “Orthotic care reimbursements RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/227126.
