Rising operational costs. Tightening margins. Labor shortages. Complex reimbursement mechanisms. These are challenging situations confronting healthcare circles as the industry transitions towards a tough phase. This blog explores medical billing strategies that can help orthotics and prosthetics practices win in the long run
Custom orthotics will be covered only if it meets medical necessity guidelines and the podiatrist or provider prescribes them as a part of the treatment plan. It is also crucial that the custom orthotics are purchased from a Medicare-participating provider. Documenting the medical necessity of the device is essential to avoid claim denials.
Obtain a detailed prescription from referring physicians specifying the type and necessity of the O&P device. Include supporting documentation such as clinical notes, imaging reports, and functional assessments to justify medical necessity.
Thorough documentation is crucial. Include detailed descriptions of the patient's condition necessitating the device, measurements, fitting process, and any modifications made. This supports medical necessity and justifies reimbursement.
Use appropriate modifiers to indicate specific circumstances that may affect reimbursement, such as bilateral procedures, multiple devices, or replacement items.
It is crucial to know the distinction between billing for the device itself (product) and the fitting/service (procedure). Ensure separate billing if applicable, using the appropriate codes and modifiers.
The CMS recently issued the Final Rule that includes a provision to formalize the definition of a brace or orthosis. This paves the way for clearer reimbursement mechanisms. Coverage policies change often and keeping up with evolving guidelines is important to get paid without delays or workarounds.
The billing cycle of orthotics and prosthetics practices is fragmented and long. This results in process inefficiencies and redundant work. Automating routine functions such as claim status tracking and payment posting increases payment accuracy and billing efficiency
Billing for O&P requires specialty-specific expertise and technology to enable great financial outcomes. Want to know how to crush revenue goals as you move towards the last quarter of 2024? Meet us at the AOPA and we will share best practices, insider tips and strategies to deploy automation at the right places to achieve optimal ROI.