Do You Have the Right Stuff: Tales From the Audit Trail

Tuesday, Oct 20, 2020

They’re Back! Have you received an audit lately? To the surprise of some, audits of various levels are back. Most of these are post-payment audits, and the reinstatement of pre-payment Target Probe & Educate (TPE) audits is yet to come. TPE audits are intended to increase billing accuracy in very specific areas. The Medical Administrative Contractors (MAC’s) use data analysis to identify providers and suppliers who report unusually high error rates or unusual billing practices and items and services with high national error rates which present a financial risk to Medicare.

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How Does O&P Fit into the Hospital of the Future?

Wednesday, Sep 2, 2020

In the current COVID, and what we hope will soon be the post-COVID time, it seems everything is changing or has changed. As the healthcare world around O&P change, those in O&P have to look at what strategic decisions to make based on these changes. O&P tends to drive its bus looking in the narrow rear-view mirror, wishing to return to the good old days rather than taking a broad view through the windshield looking at what’s coming.

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Could a Narrow Network Be in Your Future?

Tuesday, Aug 4, 2020

It has been 10 years now since the passage of the Patient Protection and Affordable Care Act (PPACA, AKA the ACA) in March 2010. In this period of time many provider groups have collaborated with many payer groups to achieve better healthcare. There certainly are proponents for and against this act, however one of the best aspects of this Act was the creation of the Triple-Aim: The Triple-Aim Who could argue against these goals?

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Summary of CMS Consensus Report on LLP

Sunday, Jul 12, 2020

A number of people have asked about the previous posts and where all of this has come from? I have referenced the CMS and AHRQ reports and provided some snippets from each. A lot of people in and around O&P are unaware of these and/or have not read them. They should be required reading as they are very instructive. I will attempt to summarize these starting with the CMS Consensus Report and will attempt to bring some clarity and background to the statements made in this document.

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Why Evidence Matters or Why O&P Cannot Use Evidence - Yet

Sunday, Jun 7, 2020

All would agree, evidence matters in healthcare to achieve the best possible outcome for the patient, the provider, and the payer – i.e. society. Healthcare providers are encouraged to use the best possible research-based evidence in making decisions about the care provided. As clinicians our patients confront us with problems needing to be solved. To solve these problems, we continually educate ourselves through attending conferences and/or reading relevant research.

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Outcome Confusion

Saturday, May 9, 2020

No wonder so many in O&P are not involved in collecting formal outcome data on their patients; we are confused as to why, how and what. Those supposedly in-the-know are confused on what is an outcome and how to measure it. As defined by the Oxford dictionary, an outcome is, “…the way a thing turns out, a consequence.” Meriam-Webster defines an outcome as, “…something that follows as a result or consequence.

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Take A Deep Breath and Focus

Monday, Apr 20, 2020

Many of you have asked me about what you should be doing NOW. The short is answer is prepare for the future. OK, great but exactly what does this mean? Two things should get your attention; 1) Take some time to understand your financials. Specifically, your Balance Sheet. It is often said, opportunity lies in your P&L and Risk lies in your Balance sheet. Why? Because the Balance Sheet shows you your Current Short-Term (less the 12 months) and Long-Term (greater than 12 months) Assets and Liabilities.

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