Third-Party Payers and You
The following post was written by ADVANCE guest blogger Brian Knutsen, OTR/L, CHT, president of Buzzards Bay Hand Therapy LLC, located in Marion and Lexington, MA.
SAN DIEGO -- In the CSM session, "Practice, Coding, Documentation and Reimbursement," Nancy Beckley, MS, MBA, CHC, shared a quick Medicare update to start. The audience then launched into a brief discussion about how confusing and downright inconsistent Medicare billing standards have become in the practice of hand therapy.
It was comforting for me to hear other clinicians from around the country explain their frustrations and scenarios that paralleled those in my own small practice in Massachusetts. Being a small clinic owner with only one employee (myself), I complete all the billing and coding on my own. It's apparent to me now that similar issues occur in larger clinics and facilities that have an entire department dedicated to billing issues.
Despite our frustrations with Medicare and other private payers, we learned that we must work hard to be as compliant as possible in order to protect ourselves legally, as well as ensure we are paid appropriately for the care we provide our patients. Lynn S. McGivern, JD, LLM, shared helpful specifics regarding standards for good compliance for DME in rehab clinics. I'll be sure to check out the Palmetto website for detailed information about DME standards and review my own compliance policies when I return home from the conference.
Bridget Morehouse, PT, MBA, touched on coverage and reimbursement as they relate to varying commercial payers. Although I would have much rather attended a session relating to clinical practice, this session was imperative for me to attend. The information is vital for clinicians striving to remain updated and compliant with coding and billing requirements. Ultimately if we don't keep abreast of these requirements, despite our frustration with third-party payers, we'll lose the reimbursement we all deserve and possibly open ourselves up to legal issues.
What does your clinic do to ensure compliance?