I have to admit it has been an extremely busy time for me over the past several months, especially getting adjusted to a new living environment here is Los Angeles, CA. However, after a couple of months, things are back on track and moving forward as always.

With that being said, part of my "busyness" (if a word) included several conference calls with Medicare over the past couple of weeks. All those who know me and have attended any of my claims and billing symposiums over the past 5 years will know that I ask "Specific Questions and want Specific Answers", and that was my mission during those calls.

I did find out the latest scoop on Facility Accreditation, and long story short, O&P Facilities need to be prepared for potential changes to Facility Accreditation and exemption status. WARNING...THIS MAY CHANGE AT ANY TIME!!! Orthotists and Prosthetists are currently exempt from F.A. right now, but as policies are continually reviewed, you may be in for a shock. I always advise my clients to apply now and wait in line for your number to be called (site visit). You know the old saying...you snooze, you loose. In this case, it just may be the case if you wait too long. Accrediting Organizations are extremely back logged and (in my humble opinion) under staffed, to accomplish the September 30, 2009 deadline. I still have clients waiting for results from October 2008...what does that tell you???

Same song and dance with "Surety Bonds". Orthotists and Prosthetists are exempt today, with no prior legal actions I might note, but...tomorrow could be a different story as legislation has this on hold at the current time. Stay tuned to this one!

Now, on to insurance...gotta love insurance companies, right? WRONG! Always trying any tactics to hold up claims, deny authorizations, request additional documentation, yada, yada...but, the worst things about insurance companies, to me are...

1. They hire people that you CANNOT UNDERSTAND! Yes, I have a weakness, a problem if you will, when I have to continually repeat myself over and over again to try to get the RIGHT ANSWERS from a person who can barely speak english! Step it up insurance companies...if you are going to hire folks who barely speak english, perhaps you should consider sending them to an "English" training class or spend a little more in salaries to hire those who can speak English.

2. Insurance Companies repeatedly tell you the "BASICS" relating to patient coverage and benefits. Word to the wise...if you don't ask the right questions, you may not get paid!!! Recently, I helped a client with several billing problems from claims that were submitted by another individual. The claims that I assisted in were claims that were denied and they wanted me to audit and find out why, I did just that. After reviewing the claim, I also reviewed the insurance verification forms for each of these patients...well, it was easy to diagnose the problem...THE CLAIMS SHOULD HAVE BEEN DENIED, because the person who processed the insurance verification did not complete the form in its entirety and did not ask specific questions relating to THAT PARTICULAR TYPE OF SERVICE (LCODES). they only asked the "Generic" questions. Generic questions, get generic answers! Shame, shame, shame on those who do not ask the right questions.

3.Insurance companies encourage providers to file electronic claims for "faster claim processing and payment"...as we would say in Texas "Bull Hockey"!!! Not for O&P anyway. Sure, they process your electronic claims within 10-14 days as they agree...but, typically what happens is they will generate a letter requesting additional documentation, medical necessity, etc. and send it to the provider. The provider receives the letter and when the insurance department has time to respond, they send the information back, and the claim is "reconsidered" for payment. Someone, please do the math here!!! If you send your paper claims, along with the attachment medical necessity docs, then your claim can actually be processed much quicker than the 10-14 days. Think I'm crazy? I just turned around another clients reimbursement by sending their claims the way I have always submitted my claims and whooohooo...those claims were processed within 7-8 business days from the DAY I MAILED THE CLAIMS, and not the day they received it! Gotta know how insurance companies operate.

Enough about insurance for now...time for a nice, relaxing weekend in Sunny California! Have a great weekend everyone, and I will try to blog more often.