Since 2012, our consultancies have helped many companies, large and small, successfully navigate the healthcare policy and procedure requirements associated with the orthopedic and durable medical equipment device market. When we are involved, stress levels go down for our clients and profits go up. That’s a win-win. The stress levels for patients go down as well when their providers are able to work through the issues of documentation and billing successfully.

Following World War II and during the polio epidemic, artificial limb (prosthetics) and orthopedic bracing (orthotics) were big deals; and still are. Providing comprehensive prosthetic and orthotic care for patients in those days was much different. In consultation with appropriate physicians, artificial limbs and orthopedic braces were dispensed in concert with a trained medical team. Patients were evaluated, devices were fabricated accordingly, and invoices for services rendered were written on carbon copied pages in long hand. Life in those days was challenging, but certainly more simplified in many ways.

In the 1970’s however, things began to change. Medicare was a new government program and computers were just starting to be integrated into the business marketplace. Since computers could not logically interpret long hand documents, numbering and coding systems became the work-in-process of the day and was, frankly, a moving target. With each passing year, more and more clinical documentation complexity was added to the requirements for medical practitioners. As system complexity grew, so did the problems for health care providers. Rather than simplify health care, it was sent on a pathway of confusion and chaos, all in the name of efficiency and political correctness. Today, our healthcare system is infiltrated with many illogical and inefficient procedures. Human errors can occur within the health insurance and government agencies without consequence, but not so much for the healthcare provider and patient. As such, we now have a government bureaucracy of healthcare auditors trying to keep our healthcare system in-line with the often unreasonable requirements set forth by regulators and policymakers. Some of our team members grew up in this evolving healthcare system and are well attuned to the past and present needs of our clients today. Experience, coupled with clinical and management skills help our team provide exceptional results for our clients. Make no mistake about it, a missed dotted “i” or crossed “T”, in the age of computers is a problem. Why? Simply because humans make simple mistakes almost daily and some of the errors are not accommodated by our healthcare system. Here’s an example. If a patient is seen on Monday the 21st, and a medical professional or patient later signs a part of the patients medical record stating that they were seen on Tuesday the 22nd, medical claims will often be denied because of this discrepancy. Of course the dates are usually written in a mm/dd/yyyy format which makes this mistake easier to make. A simple 3 day window, one day before, the actual day, and one day after would solve a bundle of medical claim nightmares such as this. Logic would tell you that if a patient is seen on Monday the 21st, one of the medical professionals or patients simply forgot what day it was. This is not an unusual mistake. Until a problem such as this is accommodated with reasonable logic, both healthcare providers and patients will suffer both monetary and needless administrative hour consequences. In the meantime, our team helps healthcare providers successfully navigate the healthcare insurance and government agency rules and regulations so that valid claims are paid with a minimum of frustration. We also write appeals for services that were wrongfully denied and our success rate for claim approval is very high. But of course our primary goal is to minimize a claim disapproval in the first place by helping our client ensure that “all of the “i’s” are dotted and all the “T’s” are crossed.