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David McGill Blogger

A Solution for Your Claims Problems

Posted by David McGill | November 08, 2013

 We are pleased to announce the Ossur Prosthetic Review Program, an expansion of the Audit Team Bionic Package we brought to you earlier this year.

Who it's for.

You need the Ossur Prosthetic Review Program if: 

  • You're losing more than 5% of your prepayment claim reviews.
  • You're losing more than 5% of your Recovery Auditor audits. Or
  • You file any claims not knowing with certainty that they meet all of the relevant payer requirements.

What it is.

 If you elect to use the Ossur Prosthetic Review Program, the skilled experts at The Audit Team (formerly HMG) will perform a quality assurance review of any claim that includes an Ossur product to make sure it satisfies payer requirements. The Audit Team coordinates with a designate from your company to ensure that you get every necessary piece of paper in the claim file before you submit it for reimbursement. 

They ensure your compliance with payer requirements by using their proprietary payer information database, which allows them to identify what's missing from your claim materials. They look not only at your records, but at payer requirements for corroborating information from other medical professionals (e.g., physicians, PT's, etc.)

After The Audit Team has "certified" your claim as ready for filing, you receive back an organized "exhibit packet." That way, if you ever need to file a redetermination, reconsideration, ALJ-level or other appeal, you have all of your key exhibits already organized, labeled, and ready to be integrated into that document! This saves your staff the time and trouble of having to do that work manually themselves, speeding up your ability to file appeals (and get paid) more quickly.

FAQ's

Q: How much does this service cost?

A: $175 per claim.

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Q: I hear that other manufacturers may offer this kind of service for free. Why doesn't Ossur?

A: Any manufacturer that offers this kind of service free of charge has violated the Federal Anti-Kickback Law. In addition, any O&P that accepts that free service has also violated that law. 

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​Q: Will The Audit Team support me if the payer denies my claim?

A: The Audit Team has vast experience at all levels of appeal (up to and including ALJ). If you wish to utilize The Audit Team for an appeal, that service falls outside the base fee of $175 but can be purchased as an "a la carte" item when necessary.   

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Q: Who do I contact to learn more about this program?

A: You can call Stephanie Morgan Greene of The Audit Team at 330.209.4543 or email her at sgreene@theauditteam.com

Össur R&R

The Source for O&P Reimbursement & Regulatory News & Analysis

If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at reimbursement411@ossur.com