PATIENT CARE FACILITIES

Patient care facilities today are faced with increasing industry accreditation and governmental regulations resulting in non-revenue generating work or increased overhead expense. Meanwhile contracting pressures have compressed profit margins to single digits. To counter this, Forensic Prosthetic and Orthotic Consulting assists patient care facilities in analyzing their current business operations to ensure maximum efficiency and compliance. The analysis includes the following:

Current State
  • A focused review of financial results benchmarked against industry results. Key sustainability ratios will be addressed and explained with linkage to practice activities.
  • Market valuation
  • A random clinical compliance audit to determine level and extent of risk
  • Determination of internal cost of delivering care
    • Administrative
    • Clinical
    • Technical
  • Development of process maps illustrating what is done, who does it, when is it done, why is it done, does it need to be done, and what does it cost

Future State
  • Determining "sacred cows"
  • Linkage of financial results with process flow
    • Discussion with management regarding process change management
    • Standards development
    • Measures
    • Learning and iterations of new processes

Forensic Prosthetic and Orthotic Consulting also assists patient care centers with the prior approval process, audits, and appeals. We pride ourselves in dealing with the "miscellaneous" or ’99 code category.

LMN’s
We have had a great deal of success in formulating these letters to address your patient’s systemic conditions and matching these with coverage requirements. Our services include:

  • Investigation of payer policies
  • Review of clinical documentation
  • Virtual patient evaluation with attending prosthetist
    • Telephone conference
    • Video web call
  • Generation of draft LMN for prosthetist review and revisions

Audits
Forensic Prosthetic & Orthotic Consulting has successfully defended the practices of O&P operations in CERT, RAC, and ZPIC audits by employing a strategy, which clearly, concisely and dispassionately addresses the points of the audit probe. Our services include:
  • Verify the recoupment request is valid for the time period identified
  • Review the documentation for the files in question
  • Formulate individual responses with supporting exhibits
  • Draft Corrective Action Plans (CAP) when required
  • Educate your legal team in O&P matters when necessary

Appeals
Forensic Prosthetic & Orthotic Consulting will dissect your denial letters and correlate them to the stated coverage policies. From here we address each denial point making counter points with plausible and cogent arguments.