Medical Review Policy Matters Make no mistake, the Medical Review Policy (MRP) does matter, and it plays a key role in determining the care that is reimbursable by a payer. The MRP is an administrative and educational tool designed to help providers, physicians, and suppliers submit correct claims for payment. Medical Review Policies outline how…
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To truly understand how commercial insurance works, you need to locate the guidebook. This is often referred to as the Medical Review Policy (MRP) or Reimbursement Guidelines or Clinical Guidelines. The MRP is often made available to clinics through a provider portal or on the insurance carrier’s website. Simply conduct an internet search for that…
Certified Chiropractic Clinical Assistant Training is now available as part of Library Membership! This official training is for those who wish to certify through the Federation of Chiropractic Licensing Boards (FCLB). The KMC University Library is an online resource for chiropractors and their teams that provides access to a vast array of educational materials and resources related to Medicare, documentation, billing, coding, compliance, and the business aspects of running a chiropractic practice. It can help chiropractors and their teams stay up-to-date on the latest regulations and best practices, as well as save time and money by avoiding costly mistakes.
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Just because someone has insurance coverage for other healthcare, there is no guarantee that coverage is available for Durable Medical Equipment (DME) like custom orthotics. And then, even if there is orthotic coverage, there may be restrictive limitations on the conditions for which orthotics may be prescribed. Sometimes, the payer requires DME to be dispensed by a licensed DME supplier to be a covered benefit. This overview tutorial calls attention to the most important considerations when reviewing coverage for your patients for the potential coverage of custom orthotics through their health plan. It also includes a demonstration on how to find the Medical Review Policy for orthotics, if one exists. Download and refer to the sample Reference Document which is an example of the details in some payers’ Medical Review Policy for orthotics.
Download Reference Document
Sample Medical Review Policy (MRP) for Orthotics
What to Do? Have you ever opened a Payer Newsletter and seen something you completely disagree with regarding reimbursement or coverage? What is your first reaction? Do you jump on social media, send the link to colleagues, and threaten to go ‘all cash?’ Is there anything else you can do? At KMC University we have…
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Streamline Your Collection Process Charge entry is only as good as your practice management set up. When entering procedures and supplies, it is necessary to identify items that would be considered patient responsibility. This is the only way you can streamline your collection process and increase revenue in your clinic. Insurance Charges Assigning patient responsibility…
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Coverage and Benefits For a clinic to run efficiently, the staff must be familiar with the terms Summary Plan Documents (SPD); Summary of Benefits and Coverage (SBC); Payer Medical Review Policy (MRP); Payer Reimbursement Policy; Policy Guidelines; Payer Clinical Guidelines, and the Provider Manual. The mini-class titled MRP-What Does It Mean to Me? provides a…
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