OPIE Responses
Sara Beck
Description
Collection
Title:
OPIE Responses
Creator:
Sara Beck
Date:
11/11/2013
Text:
Hello everyone,
I wanted to share the responses I rece
Hello everyone,
I wanted to share the responses I received concerning
OPIE and how it may impact Medicare audits. Thank you to everyone who responded:
*Having OPIE has not decreased the
number of audits. As a matter of fact, our audits have increased but I
don't think it has anything to do with OPIE. We have won the vase
majority of these audits because we are proactive and get as much info as we
can prior to delivery. We have been audited numerous times on things like
shoes and inserts. Even though we win all of these cases, and we know
that we lose money by fighting them, we do it anyway to prove our track record.
I feel like they should see that we have a good history and leave us
alone but that doesn't seem to be the case. I would say that 50% of the
audits are ridiculous, unnecessary, and an error on their part. Another
45% are questionable at best but we usually have all of the information fight
it and win the battle. The other 5% are typically from 2-3 years ago
before the standards were set and well publicized. Some of these we win and
some we lose. OPIE typically helps us gather the necessary information
and produce documents quicker and more efficiently. With that being said,
we used to have all of the info in a paper chart and could pull everything from
there as well. OPIE just saves us time typing letters with patient info,
justifications, etc. instead of doing them all manually. Hope this
helps...and good luck!
*I believe the audits are across the board. I do not believe the
system for notes increases or decreases your chances of being audited. I
don't think the RAC has a separate category for companies with OPIE compared to
those without. That being said, I believe the true question would be
if this system either helps or hinders your ability to successfully keep
your payments when audited. It seems that the auditors are not
looking at the prosthetic practitioner notes, but instead looking at doctor or
physical therapist's notes. So, can OPIE help you with regard
to the doctor or physical therapist's notes? Hope this helps.
*It definitely helps with the
proper documentation that Medicare is requiring
when requesting documentation for reviews etc., but decreasing
audits, I
haven’t been here long enough to say yes to that one. I don’t see how it
would if we can't sent documentation with the electronic billing but as
mentioned before, it is much easier to compile all the correct documentation
when needed. They also have all the correct formats in OPIE. Hope this
helps a bit.
*I would not say that it decreases
your chance to be audited, but if you put the work in and fill out the
evaluation forms, do good clinic notes and do the documentation of all
components used it will provide you with a tool that reduces your exposure when
your are audited and will definitely reduce the time it takes to pull the
paperwork together. OPIE is a tool just like anything else that we use in
O and P. It is only as good as what you put in it. I can attest to
the fact that the quality of my notes and paperwork has significantly improved
since using OPIE.
*I have OPIE, It
does not directly reduce my chances of audits, but it has DRAMATICALLY increased
my chances of winning audits. I am able to complete needed documentation
in minutes, it reminds me what documents are needed before starting, before
delivering, it provides documents that meet medicare standards, it time stamps
everything, it auto populates every field (meaning when you enter date of birth
in one document it automatically puts it in every other document that asks for
date of birth) from the doctors name, to patient info to even left or right. I
think it is the only system to use in our industry.
*I believe using OPIE has better
prepared us to respond to the audits. It allows the documentation
to be easily recalled and produced. Using OPIE has helped us improve our
documentation and that has helped us prevail in the audits.
*We have been using OPIE for 3
years. We were hit by RAC audits like everyone else in our area. We won all of
them and it seems that the auditors have now given up on us. During our ABC and
Medicare inspections, we hear nothing but praise for the ease of providing all
pertinent patient information immediately upon request.
Hope this helps!
*That is a hard question to
answer. I have used OPIE for the past seven
years. I have had some audits, but they have all gone toward my favor. I
would have to say yes, it has definitely helped me remain very organized and
most likely kept me from being picked on. If I hadn't been using
OPIE I
most likely would not have won my previous cases.
*We've been using OPIE since
October 2008 and I can't tell you how much it's
helped us in general. We O&P providers have such a lengthy list of
necessary documentation we must collect from physicians; about the only way
to track it is through the WIP feature in OPIE. In fact, that is what
sold
me on the program back in 2008, as prior to that, I created my own WIP
spreadsheet (what a hassle to bounce in between programs)! We have been hit
with RAC audits and fortunately, no money has been recouped thus far. I
wouldn't say the use of OPIE decreases our potential of being audited, but it
definitely helps with the fight. WIP keeps track of all
items that have been requested, received, scanned, etc... by a color coded
system. Absolutely nothing is billed out until all items in WIP are marked
green (complete) and meet the insurance requirements. We are a small office
with 2 practitioners and 3 administrators. My gals are great at
collecting
and analyzing the notes, Rx's etc... that come in to ensure they comply with
the crazy Medicare rules. I double check everything before submitting the
claim because in the end, I'm the one fighting Medicare. I hope this helps. You
won't be disappointed!
*We use OPIE and have had a few
prepayment audits. It doesn't decrease your
potential to BE audited but it is AMAZING in passing audits the first time
through. The biggest help is the way OPIE uses color coded WIP (work in
progress). The WIP for each patient has 19 check boxes (Dispensing RX,
HIPPA, L Codes, Auth, Detailed Rx, Diabetic Verification form, Physician
Notes, Fab parts, Pt education, delivery reciept, etc). Each of these
check
boxes is color coded Red - nothing in chart, yellow - in progress, green -
good to go. At a quick glance, everyone in the office can see at any
instantaneous time if a chart is compliant and ready for delivery. Its
very
easy for practitioners and OAs to quickly check status. You don't have to
find a chart and leaf through all of the papers. Your team must be
diligent
and make sure that they follow the OPIE steps, but if everyone is working
the same process, you decrease the chances of mistakes. When you read the
AOPA reports and 15% failed due to lack of proper proof of delivery, that is
a simple mistake that OPIE will fix. The reminder that we need to obtain
physician's notes prior to delivery, while heavy in paperwork, makes filing
our Audits much quicker. If a prepayment audit comes in, we already have
all the paperwork scanned into the chart. We simply print everything out
and send it in. I am not saying that we pass every audit the first time
through, but we have been passing them eventually. A few tips that I have
learned is to try to make a title page showing every piece of paper included
(even then they
sometimes claim something is missing). Also, first time through include
physician notes whether they requested them or not. Also, include a
signature log for all physicians and practitioners involved. Hope this
information helps.
*We have been using OPIE for about 5 years. We all
love the software and can not imagine how we use to function without it.
No, it has not decreased our potential for being audited. We still
get audited. However, I personally feel we win majority of our audits
because OPIE does allow us to be so organized and thorough with our documentation.
And yes, we have been hit with many Medicare audits. I believe
Medicare audits a certain percentage of each suppliers claims per year.
Going from paper charts to OPIE was very difficult and there were MANY
growing pains for us. But, it is 100% worth it!! Let me know if I
can help or of you have any other questions.
I wanted to share the responses I rece
Hello everyone,
I wanted to share the responses I received concerning
OPIE and how it may impact Medicare audits. Thank you to everyone who responded:
*Having OPIE has not decreased the
number of audits. As a matter of fact, our audits have increased but I
don't think it has anything to do with OPIE. We have won the vase
majority of these audits because we are proactive and get as much info as we
can prior to delivery. We have been audited numerous times on things like
shoes and inserts. Even though we win all of these cases, and we know
that we lose money by fighting them, we do it anyway to prove our track record.
I feel like they should see that we have a good history and leave us
alone but that doesn't seem to be the case. I would say that 50% of the
audits are ridiculous, unnecessary, and an error on their part. Another
45% are questionable at best but we usually have all of the information fight
it and win the battle. The other 5% are typically from 2-3 years ago
before the standards were set and well publicized. Some of these we win and
some we lose. OPIE typically helps us gather the necessary information
and produce documents quicker and more efficiently. With that being said,
we used to have all of the info in a paper chart and could pull everything from
there as well. OPIE just saves us time typing letters with patient info,
justifications, etc. instead of doing them all manually. Hope this
helps...and good luck!
*I believe the audits are across the board. I do not believe the
system for notes increases or decreases your chances of being audited. I
don't think the RAC has a separate category for companies with OPIE compared to
those without. That being said, I believe the true question would be
if this system either helps or hinders your ability to successfully keep
your payments when audited. It seems that the auditors are not
looking at the prosthetic practitioner notes, but instead looking at doctor or
physical therapist's notes. So, can OPIE help you with regard
to the doctor or physical therapist's notes? Hope this helps.
*It definitely helps with the
proper documentation that Medicare is requiring
when requesting documentation for reviews etc., but decreasing
audits, I
haven’t been here long enough to say yes to that one. I don’t see how it
would if we can't sent documentation with the electronic billing but as
mentioned before, it is much easier to compile all the correct documentation
when needed. They also have all the correct formats in OPIE. Hope this
helps a bit.
*I would not say that it decreases
your chance to be audited, but if you put the work in and fill out the
evaluation forms, do good clinic notes and do the documentation of all
components used it will provide you with a tool that reduces your exposure when
your are audited and will definitely reduce the time it takes to pull the
paperwork together. OPIE is a tool just like anything else that we use in
O and P. It is only as good as what you put in it. I can attest to
the fact that the quality of my notes and paperwork has significantly improved
since using OPIE.
*I have OPIE, It
does not directly reduce my chances of audits, but it has DRAMATICALLY increased
my chances of winning audits. I am able to complete needed documentation
in minutes, it reminds me what documents are needed before starting, before
delivering, it provides documents that meet medicare standards, it time stamps
everything, it auto populates every field (meaning when you enter date of birth
in one document it automatically puts it in every other document that asks for
date of birth) from the doctors name, to patient info to even left or right. I
think it is the only system to use in our industry.
*I believe using OPIE has better
prepared us to respond to the audits. It allows the documentation
to be easily recalled and produced. Using OPIE has helped us improve our
documentation and that has helped us prevail in the audits.
*We have been using OPIE for 3
years. We were hit by RAC audits like everyone else in our area. We won all of
them and it seems that the auditors have now given up on us. During our ABC and
Medicare inspections, we hear nothing but praise for the ease of providing all
pertinent patient information immediately upon request.
Hope this helps!
*That is a hard question to
answer. I have used OPIE for the past seven
years. I have had some audits, but they have all gone toward my favor. I
would have to say yes, it has definitely helped me remain very organized and
most likely kept me from being picked on. If I hadn't been using
OPIE I
most likely would not have won my previous cases.
*We've been using OPIE since
October 2008 and I can't tell you how much it's
helped us in general. We O&P providers have such a lengthy list of
necessary documentation we must collect from physicians; about the only way
to track it is through the WIP feature in OPIE. In fact, that is what
sold
me on the program back in 2008, as prior to that, I created my own WIP
spreadsheet (what a hassle to bounce in between programs)! We have been hit
with RAC audits and fortunately, no money has been recouped thus far. I
wouldn't say the use of OPIE decreases our potential of being audited, but it
definitely helps with the fight. WIP keeps track of all
items that have been requested, received, scanned, etc... by a color coded
system. Absolutely nothing is billed out until all items in WIP are marked
green (complete) and meet the insurance requirements. We are a small office
with 2 practitioners and 3 administrators. My gals are great at
collecting
and analyzing the notes, Rx's etc... that come in to ensure they comply with
the crazy Medicare rules. I double check everything before submitting the
claim because in the end, I'm the one fighting Medicare. I hope this helps. You
won't be disappointed!
*We use OPIE and have had a few
prepayment audits. It doesn't decrease your
potential to BE audited but it is AMAZING in passing audits the first time
through. The biggest help is the way OPIE uses color coded WIP (work in
progress). The WIP for each patient has 19 check boxes (Dispensing RX,
HIPPA, L Codes, Auth, Detailed Rx, Diabetic Verification form, Physician
Notes, Fab parts, Pt education, delivery reciept, etc). Each of these
check
boxes is color coded Red - nothing in chart, yellow - in progress, green -
good to go. At a quick glance, everyone in the office can see at any
instantaneous time if a chart is compliant and ready for delivery. Its
very
easy for practitioners and OAs to quickly check status. You don't have to
find a chart and leaf through all of the papers. Your team must be
diligent
and make sure that they follow the OPIE steps, but if everyone is working
the same process, you decrease the chances of mistakes. When you read the
AOPA reports and 15% failed due to lack of proper proof of delivery, that is
a simple mistake that OPIE will fix. The reminder that we need to obtain
physician's notes prior to delivery, while heavy in paperwork, makes filing
our Audits much quicker. If a prepayment audit comes in, we already have
all the paperwork scanned into the chart. We simply print everything out
and send it in. I am not saying that we pass every audit the first time
through, but we have been passing them eventually. A few tips that I have
learned is to try to make a title page showing every piece of paper included
(even then they
sometimes claim something is missing). Also, first time through include
physician notes whether they requested them or not. Also, include a
signature log for all physicians and practitioners involved. Hope this
information helps.
*We have been using OPIE for about 5 years. We all
love the software and can not imagine how we use to function without it.
No, it has not decreased our potential for being audited. We still
get audited. However, I personally feel we win majority of our audits
because OPIE does allow us to be so organized and thorough with our documentation.
And yes, we have been hit with many Medicare audits. I believe
Medicare audits a certain percentage of each suppliers claims per year.
Going from paper charts to OPIE was very difficult and there were MANY
growing pains for us. But, it is 100% worth it!! Let me know if I
can help or of you have any other questions.
Citation
Sara Beck, “OPIE Responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/235785.
