This just in, IT WILL AFFECT OPTOMETRISTS AND OPTOMETRIC BILLERS ALIKE!
Medicare Working with Ordering and Referring Providers and Suppliers to Streamline Enrollment Process
The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need. PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.
As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010. While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems. CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.
CMS issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) , and certain items and services under Medicare Part B. The new law applies to orders, referrals and certifications made on or after July 1. The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued.
The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.
Many physicians and other providers and suppliers have continued to make good faith efforts to comply with the requirements of the law and regulation. These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.
While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.
Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and certifications are only issued by eligible professionals effective July 1.
CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will work with the provider community to provide guidance on enrollment and will process all applications expeditiously.
opticXpress is an optometric billing company that provides a clearinghouse, billing service and software strictly for optometrists.
Friday, July 9, 2010
Thursday, June 17, 2010
Accounts Receivable and Optometric Billing
It is no secret that the average doctors office, all optometrists included, have an outstanding accounts receivable balance that is 90 days or more past due. The weird part that most doctors overlook, however, is two-fold.
#1) The total A/R balance that is 90+ days overdue is roughly 10-15% of the total amount billed to both patients and insurance. (This statistic is only for a "healthy" practice that bills correctly and enjoys a regular and reliable cash-flow.)
#2) If you look at that 90+ day overdue number carefully, you will likely discover that almost 80% of that money is PATIENT BALANCES, NOT INSURANCE MONEY DUE!
Look at that closely! These numbers indicate that insurance companies are doing their part and paying you on time for correctly coded and billed insurance claims; it is patients, however, that are falling behind in their payments! This is an industry fact that holds true among every professional medical practice and is not relegated only to optometry! In fact, I even believe that many, smaller, optometrist practices have higher percentages of patient balances outstanding due to their belief that being soft on patients who owe money or writing it off all together will retain clients. This simply is not true. In all honesty, a patient that doesn't pay his bill is most likely not coming back anyway and had no intention of keeping up their end of the bargain to begin with, but that is another topic for another post!
These numbers are astounding and when put into a real world scenario can be the difference between a very profitable practice and a not-so profitable one. Take, for example, ABC Vision Associates (clearly a made up name). ABC is a very good sized optometric facility that bills 1.5 million dollars in services and materials annually. At present, their weekly A/R is roughly $29,000.00 and their total A/R for this past month is $52,000.00, 10% of which is 90+ days outstanding. Of the $5,200.00 outstanding, $4,160.00 are patient balances that reflect co-pays, deductibles, co-insurances, lapsed policy charges etc. $4,100.00 PER MONTH IS PATIENT'S RESPONSIBILITY CHARGES FOR THIS EXAMPLE PRACTICE! IN A YEAR'S TIME THAT IS $49,920.00 IN PATIENT OVER DUE BALANCES THAT ABC MAY NEVER COLLECT UNLESS THEY HIRE THE SERVICES OF A COLLECTION AGENCY WHO WILL UN-DOUBTEDLY SKIM ANOTHER 30% OF THAT OFF THE TOP IF AND WHEN THEY COLLECT THAT BALANCE!
These numbers are critical because they show that the average optometrist's practice is loosing roughly 4% annually as a result of patient balances that are not settled; couple that with the average annual insurance write off of 20% and the picture becomes more grim. By the end of this fiscal year 2010, ABC will have lost $360,000.00 of their A/R as a result of insurance write-off's and patient balances and the numbers show that ABC's owners will accept that as reality and the cost of doing business. ABC, like most other average Optometric facilities is willing to take a 24% hit because they just don't realize that they don't have too!
There is a silver lining and it starts with sound financial planning. The first, and most important thing that an optometric facility can do is realize that insurance is and always will be your #1 source of income. The only thing that is gauranteed in this business is that no matter how much it is, insurance will always pay.
The second thing the shrewd optometrist can do is become what we call here at opticXpress, "insurance centric". This means, first and foremost, choose an office management software that guarantees you a steady cash-flow. Currently, the only piece of software that does this is opticXpress Software which REQUIRES your staff to enter the most important information into the office management system that almost, unilaterally guarantees zero or low (1.5% or less) rejection rates. Once this info is entered into the system, the software automatically bills insurance companies so your staff does not have to spend the extra time required editing and "batching" files, then uploading them to a clearinghouse or insurance company.
The third, and possibly most difficult and critical decision that you need to make as an optometrist is to allow yourself to focus on the health of your patients while an outside business management entity focuses on the health of your practice. In the case of ABC, had they hired opticXpress as their optometric billing service and utilized the opticXpress software, they would have the best and least expensive method around to collect that extra $49,000.00 per year they would otherwise have to leave on the table. OUTSOURCING YOUR OPTOMETRIC BILLING IS THE SMARTEST AND MOST INFORMED DECISION YOU CAN MAKE AS A PRACTICE OWNER BECAUSE YOU WILL BE ENTRUSTING THE FISCAL HEALTH OF YOUR PRACTICE TO AN ENTITY THAT LIVES BY THE NUMBERS AND SUCCEEDS BECAUSE THEY GET RESULTS! Simply, if they fail they loose business and that is not an option for a company that wants to grow and succeed.
So, there you have it. The results are in. This problem is only going to get worse as the days and months progress since out-of pocket health care expenses are on the rise. Get on top of your optometric billing and give opticXpress a call today!
#1) The total A/R balance that is 90+ days overdue is roughly 10-15% of the total amount billed to both patients and insurance. (This statistic is only for a "healthy" practice that bills correctly and enjoys a regular and reliable cash-flow.)
#2) If you look at that 90+ day overdue number carefully, you will likely discover that almost 80% of that money is PATIENT BALANCES, NOT INSURANCE MONEY DUE!
Look at that closely! These numbers indicate that insurance companies are doing their part and paying you on time for correctly coded and billed insurance claims; it is patients, however, that are falling behind in their payments! This is an industry fact that holds true among every professional medical practice and is not relegated only to optometry! In fact, I even believe that many, smaller, optometrist practices have higher percentages of patient balances outstanding due to their belief that being soft on patients who owe money or writing it off all together will retain clients. This simply is not true. In all honesty, a patient that doesn't pay his bill is most likely not coming back anyway and had no intention of keeping up their end of the bargain to begin with, but that is another topic for another post!
These numbers are astounding and when put into a real world scenario can be the difference between a very profitable practice and a not-so profitable one. Take, for example, ABC Vision Associates (clearly a made up name). ABC is a very good sized optometric facility that bills 1.5 million dollars in services and materials annually. At present, their weekly A/R is roughly $29,000.00 and their total A/R for this past month is $52,000.00, 10% of which is 90+ days outstanding. Of the $5,200.00 outstanding, $4,160.00 are patient balances that reflect co-pays, deductibles, co-insurances, lapsed policy charges etc. $4,100.00 PER MONTH IS PATIENT'S RESPONSIBILITY CHARGES FOR THIS EXAMPLE PRACTICE! IN A YEAR'S TIME THAT IS $49,920.00 IN PATIENT OVER DUE BALANCES THAT ABC MAY NEVER COLLECT UNLESS THEY HIRE THE SERVICES OF A COLLECTION AGENCY WHO WILL UN-DOUBTEDLY SKIM ANOTHER 30% OF THAT OFF THE TOP IF AND WHEN THEY COLLECT THAT BALANCE!
These numbers are critical because they show that the average optometrist's practice is loosing roughly 4% annually as a result of patient balances that are not settled; couple that with the average annual insurance write off of 20% and the picture becomes more grim. By the end of this fiscal year 2010, ABC will have lost $360,000.00 of their A/R as a result of insurance write-off's and patient balances and the numbers show that ABC's owners will accept that as reality and the cost of doing business. ABC, like most other average Optometric facilities is willing to take a 24% hit because they just don't realize that they don't have too!
There is a silver lining and it starts with sound financial planning. The first, and most important thing that an optometric facility can do is realize that insurance is and always will be your #1 source of income. The only thing that is gauranteed in this business is that no matter how much it is, insurance will always pay.
The second thing the shrewd optometrist can do is become what we call here at opticXpress, "insurance centric". This means, first and foremost, choose an office management software that guarantees you a steady cash-flow. Currently, the only piece of software that does this is opticXpress Software which REQUIRES your staff to enter the most important information into the office management system that almost, unilaterally guarantees zero or low (1.5% or less) rejection rates. Once this info is entered into the system, the software automatically bills insurance companies so your staff does not have to spend the extra time required editing and "batching" files, then uploading them to a clearinghouse or insurance company.
The third, and possibly most difficult and critical decision that you need to make as an optometrist is to allow yourself to focus on the health of your patients while an outside business management entity focuses on the health of your practice. In the case of ABC, had they hired opticXpress as their optometric billing service and utilized the opticXpress software, they would have the best and least expensive method around to collect that extra $49,000.00 per year they would otherwise have to leave on the table. OUTSOURCING YOUR OPTOMETRIC BILLING IS THE SMARTEST AND MOST INFORMED DECISION YOU CAN MAKE AS A PRACTICE OWNER BECAUSE YOU WILL BE ENTRUSTING THE FISCAL HEALTH OF YOUR PRACTICE TO AN ENTITY THAT LIVES BY THE NUMBERS AND SUCCEEDS BECAUSE THEY GET RESULTS! Simply, if they fail they loose business and that is not an option for a company that wants to grow and succeed.
So, there you have it. The results are in. This problem is only going to get worse as the days and months progress since out-of pocket health care expenses are on the rise. Get on top of your optometric billing and give opticXpress a call today!
Monday, June 14, 2010
Optometric Billing and the HIT Act
It has been a long time since we have updated our blog here at opticXpress. However, we hope to change that beginning today. As you may know, the government is in the process of implementing the HIT Act which will, hopefully, allow optometrists to take advantage of stimulus funds apportioned for those who implement EHR/EMR systems. Take a look at what one of our clients' optometric societies released today:
"PECOS ENROLLMENT REQUIRED FOR MEDICARE ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM - ONE MORE REASON TO ESTABLISH YOUR ENROLLMENT RECORD IN PECOS
The Recovery Act of 2009 established CMS programs under Medicare and Medicaid to provide incentive payments for the “meaningful use” of certified EHR technology. These EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they demonstrate adoption, implementation, upgrading or meaningful use of certified EHR technology.
While more detail on the EHR incentive program is forthcoming in the an impending final rule, CMS is announcing that Provider Enrollment, Chain and Ownership System (PECOS) records will be used to verify Medicare enrollment prior to making Medicare EHR incentive payments. Your enrollment information must be in PECOS, so act now if you do not have an enrollment record in this system."
"PECOS ENROLLMENT REQUIRED FOR MEDICARE ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM - ONE MORE REASON TO ESTABLISH YOUR ENROLLMENT RECORD IN PECOS
The Recovery Act of 2009 established CMS programs under Medicare and Medicaid to provide incentive payments for the “meaningful use” of certified EHR technology. These EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they demonstrate adoption, implementation, upgrading or meaningful use of certified EHR technology.
While more detail on the EHR incentive program is forthcoming in the an impending final rule, CMS is announcing that Provider Enrollment, Chain and Ownership System (PECOS) records will be used to verify Medicare enrollment prior to making Medicare EHR incentive payments. Your enrollment information must be in PECOS, so act now if you do not have an enrollment record in this system."
You may be wondering what this has to do with opticXpress and Optometric Billing...well the bottom line is this: IT IS OUR GOAL TO HELP OUR CLIENTS COMPLY WITH THE HIT ACT'S PROVISIONS AND REQUIREMENTS. opticXpress software is being developed to comply with the HIT Act and our service is also centered around helping our clients get access to the information they need. With that in mind MAKE SURE THAT YOU SIGN UP FOR PECOS TODAY! IT NOT ONLY TAKES ALOT OF THE GUESS WORK OUT OF CREDENTIALING AND RE-CREDENTIALING FOR MEDICARE BUT IT IS ALSO AN INVALUABLE TOOL FOR UPDATING YOUR MEDICARE RECORDS AS WELL. Who knows, signing up for PECOS may just be the single most important factor when it comes to whether or not you will receive any stimulus funds in the coming years!
For more information, please contact opticXpress by visiting our optometric billing website today! Feel free to call us if you any questions about the HIT Act or our services!
Optometric Billing Services and Software Developed Exclusively for Optometrists
Optometric Billing and the HIT Act
It has been a long time since we have updated our blog here at opticXpress. However, we hope to change that beginning today. As you may know, the government is in the process of implementing the HIT Act which will, hopefully, allow optometrists to take advantage of stimulus funds apportioned for those who implement EHR/EMR systems. Take a look at what one of our clients' optometric societies released today:
"PECOS ENROLLMENT REQUIRED FOR MEDICARE ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM - ONE MORE REASON TO ESTABLISH YOUR ENROLLMENT RECORD IN PECOS
The Recovery Act of 2009 established CMS programs under Medicare and Medicaid to provide incentive payments for the “meaningful use” of certified EHR technology. These EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they demonstrate adoption, implementation, upgrading or meaningful use of certified EHR technology.
While more detail on the EHR incentive program is forthcoming in the an impending final rule, CMS is announcing that Provider Enrollment, Chain and Ownership System (PECOS) records will be used to verify Medicare enrollment prior to making Medicare EHR incentive payments. Your enrollment information must be in PECOS, so act now if you do not have an enrollment record in this system."
"PECOS ENROLLMENT REQUIRED FOR MEDICARE ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM - ONE MORE REASON TO ESTABLISH YOUR ENROLLMENT RECORD IN PECOS
The Recovery Act of 2009 established CMS programs under Medicare and Medicaid to provide incentive payments for the “meaningful use” of certified EHR technology. These EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they demonstrate adoption, implementation, upgrading or meaningful use of certified EHR technology.
While more detail on the EHR incentive program is forthcoming in the an impending final rule, CMS is announcing that Provider Enrollment, Chain and Ownership System (PECOS) records will be used to verify Medicare enrollment prior to making Medicare EHR incentive payments. Your enrollment information must be in PECOS, so act now if you do not have an enrollment record in this system."
You may be wondering what this has to do with opticXpress and Optometric Billing...well the bottom line is this: IT IS OUR GOAL TO HELP OUR CLIENTS COMPLY WITH THE HIT ACT'S PROVISIONS AND REQUIREMENTS. opticXpress software is being developed to comply with the HIT Act and our service is also centered around helping our clients get access to the information they need. With that in mind MAKE SURE THAT YOU SIGN UP FOR PECOS TODAY! IT NOT ONLY TAKES ALOT OF THE GUESS WORK OUT OF CREDENTIALING AND RE-CREDENTIALING FOR MEDICARE BUT IT IS ALSO AN INVALUABLE TOOL FOR UPDATING YOUR MEDICARE RECORDS AS WELL. Who knows, signing up for PECOS may just be the single most important factor when it comes to whether or not you will receive any stimulus funds in the coming years!
For more information, please contact opticXpress by visiting our optometric billing website today! Feel free to call us if you any questions about the HIT Act or our services!
Optometric Billing Services and Software Developed Exclusively for Optometrists
Sunday, October 4, 2009
Free Medical Billing Software for Optometrists!
For the past few months RLR Consulting has been dropping hints that it has a product in the works aimed directly and solely at optometrists. Today that day has come!
As of this week, RLR Consulting officially announces the release of its FREE, Optometric Billing Software and optometric billing services known as, "opticXpress". With the opticXpress software at its core, RLR Consulting is now a full service optometric billing company. RLR Consulting now provides not only billing services for optometrists, but they are also a software company and Optometric Clearinghouse as well.
Moving forward, opticXpress software is and always will be a FREE software to the RLR Consulting client. Currently this software allows providers to focus on patients and quality of care while reducing the amount of time spent coding and submiting insurance transactions. This is because opticXpress's intuitive design and ease of use allow the Optometrist to only input information about the patient...RLR Consulting handles the rest!
Over the next few months, as government guidelines for EMR/EHR software become available, opticXpress will be updated and become a full featured office management software that will include the easiest interface to Electronic Medical Records and Electronic Health Records available to the Optometric Client. Best of all, opticXpress will remain...FREE!
How can RLR Consulting do this? The answer is simple: RLR Consulting is a DEBT FREE company and can compete with even the largest clearing houses (such as Emdeon and Mckesson) on claim submission rates. This allows RLR to focus solely on their clients and the needs of their clients while keeping costs low and competetive year in and year out.
More information can be found at: www.opticXpress.com
As of this week, RLR Consulting officially announces the release of its FREE, Optometric Billing Software and optometric billing services known as, "opticXpress". With the opticXpress software at its core, RLR Consulting is now a full service optometric billing company. RLR Consulting now provides not only billing services for optometrists, but they are also a software company and Optometric Clearinghouse as well.
Moving forward, opticXpress software is and always will be a FREE software to the RLR Consulting client. Currently this software allows providers to focus on patients and quality of care while reducing the amount of time spent coding and submiting insurance transactions. This is because opticXpress's intuitive design and ease of use allow the Optometrist to only input information about the patient...RLR Consulting handles the rest!
Over the next few months, as government guidelines for EMR/EHR software become available, opticXpress will be updated and become a full featured office management software that will include the easiest interface to Electronic Medical Records and Electronic Health Records available to the Optometric Client. Best of all, opticXpress will remain...FREE!
How can RLR Consulting do this? The answer is simple: RLR Consulting is a DEBT FREE company and can compete with even the largest clearing houses (such as Emdeon and Mckesson) on claim submission rates. This allows RLR to focus solely on their clients and the needs of their clients while keeping costs low and competetive year in and year out.
More information can be found at: www.opticXpress.com
Saturday, August 8, 2009
New Optometric Billing Software for Walmart OD's...FREE!
RLR Consulting has written and released FREE optometric billing software for Walmart Optometrists.
Andrew Roy, the owner and president of RLR Consulting, was asked why the company decided to release this software for Walmart OD's to which he replied, " Walmart Optometrists represent a significant part of the market that encompasses not only Walmart vision centers, but other commercial franchises as well. The state of the economy is such, that many national optical corporations are trying to cut costs by no longer providing billing services as a benefit for the private OD's and optometric groups that provide the exams in their stores. As a result, many of these doctors are finding it necessary to either hire personnel to perform their medical billing or do it themselves, both of which represent a huge cost increase; something no business owner wants to encounter in this economic climate.
In order to meet the growing demand for cost saving solutions that allow OD's to perfrom their billing and remain competetive, RLR Consulting authored a FREE piece of software known as "Optic-Express". We believe that optic express is perfect for the Wal-mart OD, as well as all OD's, as it is written in such a way that it allows the doctor to see as many patients per day as possible but WITHOUT sacrificing quality of care. Optic-Express's intuitive design also generates daily medical insurance claims automatically, thereby establishing a constant and reliable cash-flow for the OD that is utilizing the software.
Another value-added feature of optic-express is that it is written to grow over time with the doctor's practice and is gauranteed to remain compliant with the ever changing EHR/EMR requirements set to be imposed by the U.S. government. These features will always remain free and the software will always remain updated, free-of charge to the provider."
More information about RLR Consulting's Walmart Billing Services.
Andrew Roy, the owner and president of RLR Consulting, was asked why the company decided to release this software for Walmart OD's to which he replied, " Walmart Optometrists represent a significant part of the market that encompasses not only Walmart vision centers, but other commercial franchises as well. The state of the economy is such, that many national optical corporations are trying to cut costs by no longer providing billing services as a benefit for the private OD's and optometric groups that provide the exams in their stores. As a result, many of these doctors are finding it necessary to either hire personnel to perform their medical billing or do it themselves, both of which represent a huge cost increase; something no business owner wants to encounter in this economic climate.
In order to meet the growing demand for cost saving solutions that allow OD's to perfrom their billing and remain competetive, RLR Consulting authored a FREE piece of software known as "Optic-Express". We believe that optic express is perfect for the Wal-mart OD, as well as all OD's, as it is written in such a way that it allows the doctor to see as many patients per day as possible but WITHOUT sacrificing quality of care. Optic-Express's intuitive design also generates daily medical insurance claims automatically, thereby establishing a constant and reliable cash-flow for the OD that is utilizing the software.
Another value-added feature of optic-express is that it is written to grow over time with the doctor's practice and is gauranteed to remain compliant with the ever changing EHR/EMR requirements set to be imposed by the U.S. government. These features will always remain free and the software will always remain updated, free-of charge to the provider."
More information about RLR Consulting's Walmart Billing Services.
Saturday, July 11, 2009
Twitter For Optometrists
One of the things that RLR Consulting strives to pass on to its clients is an appreciation for the latest and greatest technology. There is a reason for this, as healthcare advances it can only do so because of the advancement in technology...and so it stands to reason: If you as an optometrist are utilizing the latest and greatest technology to serve your patients then your support staff and support services should utilize the same up-to-date technology as well, or at least be willing to utilize it.
At RLR we are constantly upgrading our computer systems. We are always looking for ways to give our clients access to the latest and greatest information. We take advantage of cutting edge ideas like "cloud computing", which we will push once it starts to become more mainstreem because it will allow for a doctor to turn on any computer, any time, and access his information from all over the world and it will simply, "just work".
Recently we started using Twitter as a tool for updating our clients and prospective clients with information from RLR Consulting. We like it for one very important and basic reason: it answers the question "What are we doing?" which is something that all of our clients and prospective clients would and do want to know. As an optometrist who is utilizing our service or simply looking for a new service provider, you can always count on RLR Consulting to update you on exactly what we are doing and, if you sign up for twitter yourself, you will be able to answer back and even post comments that we read, INSTANTLY!!!
Twitter for Optometrists? One of the best things you can do for yourself, and your practice!
__________________________________________________________________________________________________
More information about RLR Consulting and thier optometric billing services can be found at: www.optometricbilling.rlrbillingsolutions.com
At RLR we are constantly upgrading our computer systems. We are always looking for ways to give our clients access to the latest and greatest information. We take advantage of cutting edge ideas like "cloud computing", which we will push once it starts to become more mainstreem because it will allow for a doctor to turn on any computer, any time, and access his information from all over the world and it will simply, "just work".
Recently we started using Twitter as a tool for updating our clients and prospective clients with information from RLR Consulting. We like it for one very important and basic reason: it answers the question "What are we doing?" which is something that all of our clients and prospective clients would and do want to know. As an optometrist who is utilizing our service or simply looking for a new service provider, you can always count on RLR Consulting to update you on exactly what we are doing and, if you sign up for twitter yourself, you will be able to answer back and even post comments that we read, INSTANTLY!!!
Twitter for Optometrists? One of the best things you can do for yourself, and your practice!
__________________________________________________________________________________________________
More information about RLR Consulting and thier optometric billing services can be found at: www.optometricbilling.rlrbillingsolutions.com
Subscribe to:
Posts (Atom)