Education for Compliance in O&P
Jim DeWees
Description
Collection
Title:
Education for Compliance in O&P
Creator:
Jim DeWees
Date:
3/27/2013
Text:
Hello everyone,
We are now all aware of the audits. Some of us, like me, just started
dealing with this in the past couple months. There might be a few still out
there who have NOT had the pleasure of dealing with an audit request.
I have raised this question in several conversations with people in the past
few months:
WHY ISN'T ABC REQUIRING SOME FORMAL EDUCATION/TRAINING ON MEDICARE
COMPLIANCE? Along with our required continuing education credits, can't ABC
make it that part of them must be some CMS compliance education? This is
just a thought.
I am not trashing ABC, AOPA, NAAOP, Academy, etc., but I am somewhat amazed
and disappointed that nothing is being done to educate people, or reach out
and try to IMPRESS upon everyone the importance of this compliance. It is
killing some of our businesses in this profession.
I get calls all the time from ABC practitioners, and a common question comes
up: How was I supposed to know.....? Or Where was I supposed to learn
about this.....? or Where did YOU learn about these audits or these
physician's notes....?
The answer is: I DON'T KNOW! I don't know where we are really supposed to
get this factual information or help.
I learned about these audits from an Ossur meeting where they were supposed
to be talking about their Rheo knee. It turned into audit hell. I was
REALLY unhappy after attending this meeting, questioning IF they were
telling the truth. Is this REALLY happening, and HOW was I going to be able
to do this, and get this information to justify the work that I am doing.
Do others feel this same way? Honestly, I have gotten NO help from ABC,
AOPA, or any other organization.
A few months ago I attended a meeting that OPGA put on, with Otto Bock and
PEL as partners of this in Cincinnati. They went into greater detail about
what to do, BUT it was a little too late. Fortunately I had been collecting
the physician's notes before this meeting. If this was the FIRST time I had
learned about this, I would have now failed all 9 audits. I would have NOT
had the information I needed to pass the audits.
I really feel that someone in this profession MUST somehow make it a
requirement for all of us to have some formal training on what EXACTLY we
must be doing to be compliant. The reason of I just didn't know about
what to do is not enough. When so many of us in this field are failing our
audits because we don't have the documentation is horrible! It makes us all
look bad as a group. It makes this really look like the jackpot of how to
recoup the funds.
Some formal training MUST be required, OR at least it should be out there
somewhere for us to contact and learn from on our own. But, still I am not
aware of ANY program or education that I could go to and get the exact
information of what I need to do.
I have had to learn by trial and error which could have been devastating
financially IF I did not get it right. I have sent out dozens of my
examples of what I include to others to follow. But I am by no means the
expert in this topic.
The FIRST audit was really stressful. I did not know WHAT exactly they
wanted, and IF I was doing something wrong, missing something, etc. But,
now after 9 of them, I can get the audit packet ready and in the mail in
about 30 minutes. And, they must be complete as they are being approved
and PAID in about 2 weeks.
What triggers an audit? From my experience, the L-5301 and 5321 (base
codes, probably to include Symes, HD, and socket change codes as well) are
what trigger it. ALSO, it seems that any foot code for a K-3 trigger the
audit.
There is a false concept being spread around about what is getting an audit.
It is NOT the high dollar claims or just the C-leg or Rheo knee. The
audits are happening for all of the base codes for lower limb prosthetics.
A little hint I figured out this last audit. I did a K-2 limb for a
patient. There were 14 codes. I made sure that the LAST code was the
L-5301. That worked!!! I got paid in the normal time period for the first
2 pages (6 codes per claim) with no problem. Then the LAST page of the
claim with 2 codes was the one that was audited.
I submitted the information (physician's notes, delivery ticket, my notes,
Rx, etc) the very same day that I got it. The leg was delivered on Feb 25
(Mon). I got the audit request on Monday March 4 (7 days). I submitted the
information on Mar. 4th. Then on March 18th, I got the audit report back,
the EOB that was PAID, and the money was already in my checking account.
This is the norm now for my audits.
If you have everything in order, you should also be able to expect this same
processing time (at least that it what the supervisor is saying to me). OR
maybe I have just screamed at them enough times, and have pushed their
buttons enough that they are giving me special treatment to keep me shut
up.....who knows.) (I bet there are some on this list that wish I would
also shut up....haha)..
So, this might be something for you all to do. Make sure the base code is
the LAST code, and hopefully where it will be the only code, or with just a
couple other codes. There is NOTHING unethical about this, there is nothing
wrong with where you put the base code. But it was nice to at least get
paid quickly for the foot, liners, and other additional codes in the normal
time (10 days or so), and then just have to fight for a couple of the codes,
and a small portion of the overall claim.
Take care everyone.
Jim DeWees, CP
We are now all aware of the audits. Some of us, like me, just started
dealing with this in the past couple months. There might be a few still out
there who have NOT had the pleasure of dealing with an audit request.
I have raised this question in several conversations with people in the past
few months:
WHY ISN'T ABC REQUIRING SOME FORMAL EDUCATION/TRAINING ON MEDICARE
COMPLIANCE? Along with our required continuing education credits, can't ABC
make it that part of them must be some CMS compliance education? This is
just a thought.
I am not trashing ABC, AOPA, NAAOP, Academy, etc., but I am somewhat amazed
and disappointed that nothing is being done to educate people, or reach out
and try to IMPRESS upon everyone the importance of this compliance. It is
killing some of our businesses in this profession.
I get calls all the time from ABC practitioners, and a common question comes
up: How was I supposed to know.....? Or Where was I supposed to learn
about this.....? or Where did YOU learn about these audits or these
physician's notes....?
The answer is: I DON'T KNOW! I don't know where we are really supposed to
get this factual information or help.
I learned about these audits from an Ossur meeting where they were supposed
to be talking about their Rheo knee. It turned into audit hell. I was
REALLY unhappy after attending this meeting, questioning IF they were
telling the truth. Is this REALLY happening, and HOW was I going to be able
to do this, and get this information to justify the work that I am doing.
Do others feel this same way? Honestly, I have gotten NO help from ABC,
AOPA, or any other organization.
A few months ago I attended a meeting that OPGA put on, with Otto Bock and
PEL as partners of this in Cincinnati. They went into greater detail about
what to do, BUT it was a little too late. Fortunately I had been collecting
the physician's notes before this meeting. If this was the FIRST time I had
learned about this, I would have now failed all 9 audits. I would have NOT
had the information I needed to pass the audits.
I really feel that someone in this profession MUST somehow make it a
requirement for all of us to have some formal training on what EXACTLY we
must be doing to be compliant. The reason of I just didn't know about
what to do is not enough. When so many of us in this field are failing our
audits because we don't have the documentation is horrible! It makes us all
look bad as a group. It makes this really look like the jackpot of how to
recoup the funds.
Some formal training MUST be required, OR at least it should be out there
somewhere for us to contact and learn from on our own. But, still I am not
aware of ANY program or education that I could go to and get the exact
information of what I need to do.
I have had to learn by trial and error which could have been devastating
financially IF I did not get it right. I have sent out dozens of my
examples of what I include to others to follow. But I am by no means the
expert in this topic.
The FIRST audit was really stressful. I did not know WHAT exactly they
wanted, and IF I was doing something wrong, missing something, etc. But,
now after 9 of them, I can get the audit packet ready and in the mail in
about 30 minutes. And, they must be complete as they are being approved
and PAID in about 2 weeks.
What triggers an audit? From my experience, the L-5301 and 5321 (base
codes, probably to include Symes, HD, and socket change codes as well) are
what trigger it. ALSO, it seems that any foot code for a K-3 trigger the
audit.
There is a false concept being spread around about what is getting an audit.
It is NOT the high dollar claims or just the C-leg or Rheo knee. The
audits are happening for all of the base codes for lower limb prosthetics.
A little hint I figured out this last audit. I did a K-2 limb for a
patient. There were 14 codes. I made sure that the LAST code was the
L-5301. That worked!!! I got paid in the normal time period for the first
2 pages (6 codes per claim) with no problem. Then the LAST page of the
claim with 2 codes was the one that was audited.
I submitted the information (physician's notes, delivery ticket, my notes,
Rx, etc) the very same day that I got it. The leg was delivered on Feb 25
(Mon). I got the audit request on Monday March 4 (7 days). I submitted the
information on Mar. 4th. Then on March 18th, I got the audit report back,
the EOB that was PAID, and the money was already in my checking account.
This is the norm now for my audits.
If you have everything in order, you should also be able to expect this same
processing time (at least that it what the supervisor is saying to me). OR
maybe I have just screamed at them enough times, and have pushed their
buttons enough that they are giving me special treatment to keep me shut
up.....who knows.) (I bet there are some on this list that wish I would
also shut up....haha)..
So, this might be something for you all to do. Make sure the base code is
the LAST code, and hopefully where it will be the only code, or with just a
couple other codes. There is NOTHING unethical about this, there is nothing
wrong with where you put the base code. But it was nice to at least get
paid quickly for the foot, liners, and other additional codes in the normal
time (10 days or so), and then just have to fight for a couple of the codes,
and a small portion of the overall claim.
Take care everyone.
Jim DeWees, CP
Citation
Jim DeWees, “Education for Compliance in O&P,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/234815.
