All Hail the Admin Team!
Archive Select, Originally Published April 22, 2021, Updated March 14, 2023
In about a month we will recognize “Administrative Professional’s Day .” If you are an Owner or COO, DO NOT SKIP THIS BLOG! I know that administrators really are the grease that makes the practice work, but boy was I ever unaware about how much responsibility they really have!
In O&P, the glory goes to the clinician. But if they only knew what the admins do to make sure the company gets paid for that glorious work! The administrative professionals that are running your practice have about a gazillion different tasks to perform between the time they learn about a new prescription/patient and when you deposit payment for the services you render. First there are data entry, insurance validation, referral source validation (through PECOS) and patient verification processes that must be completed. Then a quick review of NCDs, LCDs, and policy articles for each code the clinicians select. After all, they need to make sure you are meeting all of the coverage requirements. And since the requirements seem to change in the blink of an eye, they really should be consulted very regularly to ensure you have the latest information. Is preauthorization required?
And let us not forget about the Medicare Competitive Bid program. Do you think it does not apply to you? Well, it does! O&P providers will not be reimbursed if they supply a covered device to a patient who lives in a zip code won by a contracted supplier. They need to determine if the proposed device is covered by competitive bid, and if so, if the patient’s home address zip code is in a covered area.
And we have just gotten to the “Codes sent to Admin” part!
Once they know the specific device the clinician wants to use, the admin needs to see if a PDAC letter is needed. If so, they need to obtain a copy of that letter and make sure they can produce it in case of an audit. PDAC letters can be revoked, and once revoked they are no longer referenced on the PDAC website, so it is important that your copy can be retrieved locally.
Certain codes also require modifiers. So, admins must be aware of those and ensure that the proper modifiers are selected. The LCDs, NCDs, and policy articles will specify this, but sometimes the proper choice can only be done in consultation with a clinician. Knowing when they are required and what additional documentation they entail is the job of the admin.
All right! We made it to delivery. Before that occurs, the admin must recheck that the referring physician is still in good standing with PECOS, the patient’s insurance is still valid, the patient responsibility has been paid (or there is a plan in place), all paperwork is properly prepared, and the medical necessity is clearly present in the medical record. Usually, this will require verification by ANOTHER clinician in the office, not the practitioner in charge.
Now that it is delivered the compliance and audit processes begin in earnest. The goal should be to get the claim billed within two days of delivery. If all the work is done on the front-end, the biller’s job should be smooth. Your administrative staff keeps your clinical and your business processes running smoothly. A successful, efficient organization will have administrative professionals with strong organizational skills and a great attention to detail.
Most of their work and effort can be easily overlooked. Make sure your team takes this time to recognize everyone who contributes to the success of your practice. Remember to thank them, not just this week for Administrative Professional’s Day but throughout the year! Administrators, thank you, for all that you do!