Tiny Tim and The Man: Ethical issues in reimbursement I will be focusing on the reimbursement challenges that we will be facing when we enter the profession. I will also be addressing the ethical issues that will most likely go hand in hand with them. An ethical practice is a sound business. Although an ethics choice made the wrong way can produced short term positive effects and gains, it can change very quickly into a long time loss, both monetarily and professionally. Ethical practices and individuals prosper more in the long run by earning respect and trust of consumers as well as other businesses, gaining more in the end. Fairley opens his article, Where ethics and economics meet, with "The path to modern orthotic and prosthetic
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In generating prescriptions, records often include healthcare common procedure coding system (HCPCS) code that must match the device provided." Problems arise when someone thinks, well this other code pays a lot more. When a prescribing physician uses a different code then the O and P provider would use, the device won 't match and there for will not pass the audit. The orthotic and prosthetic provider can 't legally change the EMR. The physician needs to be contacted and an official request needs to be made for a change in code and an amendment to the prescription. All these steps take time, time the business is not receiving reimbursement. Some fraudulent situations are more serious. There a strict guidelines that people will choose to ignore or bend. A company or facility may potentially lose referrals if they are threatened with losing business because another company is OK breaking the rules and providing a different date of service, resulting in the insurance company double pay out on a …show more content…
Very clear and precise ethical rules have been worked out and codes of ethics are expected to be enforced. Individuals with certification are also expected to report fraud and inappropriate conduct from others in the community and field. "AOPA faces the problems of economic survival of its members. The Academy and the ABC respectively focus their attention upon professional standards of conduct and the creation of credentialing mechanics for quality assurance to the consumers and NAPOE faces challenges of basic and continuing education that is both relevant, consistent and of high
In generating prescriptions, records often include healthcare common procedure coding system (HCPCS) code that must match the device provided." Problems arise when someone thinks, well this other code pays a lot more. When a prescribing physician uses a different code then the O and P provider would use, the device won 't match and there for will not pass the audit. The orthotic and prosthetic provider can 't legally change the EMR. The physician needs to be contacted and an official request needs to be made for a change in code and an amendment to the prescription. All these steps take time, time the business is not receiving reimbursement. Some fraudulent situations are more serious. There a strict guidelines that people will choose to ignore or bend. A company or facility may potentially lose referrals if they are threatened with losing business because another company is OK breaking the rules and providing a different date of service, resulting in the insurance company double pay out on a …show more content…
Very clear and precise ethical rules have been worked out and codes of ethics are expected to be enforced. Individuals with certification are also expected to report fraud and inappropriate conduct from others in the community and field. "AOPA faces the problems of economic survival of its members. The Academy and the ABC respectively focus their attention upon professional standards of conduct and the creation of credentialing mechanics for quality assurance to the consumers and NAPOE faces challenges of basic and continuing education that is both relevant, consistent and of high