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Steps to Reimbursement Success

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by

Linda Collins

on 28 March 2015

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Transcript of Steps to Reimbursement Success

Know the Patient
Functional Levels
Linda Collins
Senior Director, Market Access
Össur Americas
reimbursement411@ossur.com

Know the Insurer
Documentation
Process
Corroborating Documentation

Steps to Reimbursement Success
Medical Necessity
LCD/Medical Policy
History
Current condition
Functional level
History
Current Condition
Desire to ambulate
Past
Future
Present
surgeries?
other healthcare professionals?
other mobility devices?
activities/functional levels?
comorbidities?
current meds?
living arrangements?
employment?
ADLs?
desire to ambulate
reach and maintain

Specifics

Data
Images
Amputee Mobility Predictor
ADLs
Activities
Time & Terrain
Past
Present
Future
Medical Record Basics
Name
Date
Credentials

Legible
You refer.
I'll treat.
Comprehensive Patient Evaluation
Medical Records
Detailed Written Order
Proof of Delivery
treating script
script for pt
past present future
match patient to product
details
legible
Patient referred

Audits/Appeals
Fight,Fight,Fight
30 days vs 120 days
Linda Collins
reimbursement411@ossur.com
www.ossur.com/randr

Functional level not adequately documented

Medical necessity of replacement
change in condition
wear & tear
60%

Desire to ambulate
ADR

espond
Past
Present
Future
Current and Expected K Level
Local Coverage Decision (LCD)
Full transcript