Getting reimbursed for orthotics and prosthetics claims is tough. But it doesn’t have to be. Identifying common billing bottlenecks and resolving them improves reimbursement and lowers denial rates.
To ensure appropriate reimbursement pay attention to co-pays and coinsurance details.
Create a strong revenue cycle framework to evaluate and strengthen current processes.
Follow payer-specific billing regulations for devices.
A prescription from the physician that indicates the necessity of the orthotics or prosthetic device.
It is important to bill appropriate modifiers KX, LT, RT etc.
It is important that orthotics and prosthetics gadgets are billed along with supporting necessary documentation. Example: A bill for diabetic socks will be reimbursed only if the diagnosis indicates diabetes.
A lot hinges on medical documentation when it comes to orthotics and prosthetics billing. Maintaining clear and updated clinical documentation is table stakes.
It is best practice to address claim denials as quickly as possible to avoid missing TFLs.
With multiple stakeholders in the billing process missed inputs such as dates of accident and provider information are the major drivers of denials.
An orthotics and prosthetics specific practice management or billing system can help in containing claim errors.
Tightening margins, evolving regulations and the constant struggle to increase referrals are driving orthotics and prosthetics businesses ‘round the bend. Following payer-specific guidelines and bedding down best practices into revenue cycle operations can shorten the path to payment and reduce costly billing mistakes.