Academy Think Tank Round Table - Session Four

This series consists of four sessions, with topics curated by the Academy's President, designed to create space for collaborative problem-solving and forward-thinking clinical dialogue.

Real World Reimbursement in O&P

Session Description:

Join the Academy's President, Dr. Gerald Stark, PhD, MSEM, CPOL, FAAOP(D), for a dynamic roundtable discussion about O&P reimbursement. This session will discuss what defensible documentation means: meeting medical necessity and policy coverage where it exists, while anticipating potential denials before and after payment. We will review current denial trends, Recovery Audit Contractor (RAC), and Medicare Advantage Programs (MAP), to help you shape documentation that withstands payer scrutiny. Additionally, we will discuss how outcomes data ties into reimbursement, particularly in supporting NOC coding for innovative technologies—ensuring your claims are not only clean but positioned for sustainable reimbursement in a changing environment.

Learning Objectives

1. 1 Define defensible documentation in O&P and identify key elements required to meet medical necessity and policy coverage.
2. 2 Describe contemporary denial trends (including S&S, RAC, MAP) and how to address them in documentation and claims proactively.
3. 3 Apply strategies to anticipate and manage potential denials, including prior authorization and post-payment audits.
4. 4 Explain how outcomes data can support reimbursement efforts, including NOC coding for innovative technologies.
5. 5 Implement practical revenue cycle management approaches to “Get Paid, Stay Paid” in today’s reimbursement environment.

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