On this episode of The O&P Check-in: an SPS Podcast, we sit down with Vice President and General Manager of O&P Insight, Lesleigh Sisson, CFo, CFm, to chat about the rising trends in payer audits, the most common causes of avoidable revenue loss, and proactive compliance strategies that help O&P clinics ensure claims get and stay paid.
The following includes an excerpt from our conversation, edited for length and clarity. Click here to listen to the full interview.
The O&P Check-in: an SPS Podcast unpacks trends and stories from the tight-knit community of O&P professionals. From patient care to technology, best practices, and regulations, this podcast features topics that help you stay current.
What specific trends are you seeing in payer audits right now?
Over the last decade, we’ve seen an increase in medical necessity scrutiny. Payers are reviewing not only our documentation, but the documents from the referring physician to ensure the devices and services we are providing are medically necessary and documented in the medical record.
Why do you think payers are intensifying their scrutiny of documentation?
Payers are focused on cost containment. They only want to pay for medical expenses that are medically necessary. It’s important that our documentation outlines our patients' devices and the services that we delivered so they can ensure that the coding in our claim is correct.
What are the most preventable causes of avoidable revenue loss in O&P billing?
Knowing your payer policy is key. We usually teach Medicare payer policy as the gold standard, but every payer has their own medical policies. Overcoming denials can be difficult, but it is not impossible, especially when you have medical necessity to back up your claim.
What does a proactive compliance program look like in a clinic?
Key elements I look for:
- Having your compliance program written down
- Reviewing it annually
- Ensuring that your employees know where to find it
- Training on your compliance annually
- Creating a team that works together within a compliance culture.
A sign of a great compliance culture is that it’s just in your DNA—every step of compliance is part of what your office does as a team on a daily basis.
Click the button below to hear the entire conversation.
To learn more about O&P Insight and how it can support your practice, visit oandpinsight.com.
