Orthotics billing best practices to improve reimbursement in 2023
Posted on 02 Feb 2023
Time to fix a fractured process.

Orthotics billing errors are commonplace. It requires specialized skills to achieve optimal reimbursement. With tightening margins and extensive reimbursement regulations it is essential to implement billing best practices to ensure financial stability in today’s uncertain healthcare climate.

The orthotics and prosthetics industry has undergone seismic changes over the last few years and as the reimbursement landscape evolves, so should standard billing practices. Optimizing billing and collections processes will prevent O&P businesses from being blindsided.

5 effective strategies to optimize the orthotics billing process
1. Focus on accurate chart notes

It is important that chart notes clearly document the medical condition of the patient, the severity of the condition, and the treatment options provided. The documentation to support medical necessity should consist of vital information like the necessity of a particular device, such as an over the counter OTA, for the patient based on clear diagnosis notes.

Making blanket statements on orthotics results in claim rejections. While billing, it is best practice to utilize two lines in the claim form. One for the right foot and the other for the left foot. This eliminates confusion.

2. Coding for casting

There is no code for casting in orthotics. Orthotic billers default to the unlisted CPT code of 29799. However, it is important to specify the details to be included within the medical code. This code denotes both the professional component as well as cast supplies.

Detailed information inputted in the claim form improves the chances of reimbursement and ensures higher first pass claim acceptance rate.

3. Establish the medical necessity of tests.

Tests to assess muscle testing and motion studies must include the necessity of carrying out the medical tests. The reason behind performing the tests such as symptoms of muscle weakness, evidence of neurological damage or systemic diseases or bio mechanical abnormalities, must be specified in detail. Insurance carriers reject claims that do not contain specific and accurate information.

Ensuring as much information is captured during the initial assessment stage prevents downstream issues.

4. Over the counter or not?

A chief problem faced by orthotics professionals is whether a patient requires an OTC solution or a custom fit. Most patients prefer customized orthotic devices. It is important to check the coverage information of the patient prior to suggesting OTC solutions. A majority of insurance carriers do not reimburse over-the-counter orthotics.

Educating patients on their payment responsibility and verifying whether they have a health savings plan safeguards providers from reimbursement problems. Health plans reimburse the dispensing of orthotic devices. Utilize the right set of codes and back them up with chart notes to improve reimbursement.

5. Focus on coding accuracy

Inaccurate codes are the chief reason behind code denials. Evaluating the accuracy of CPT/HCPCS codes assigned is a surefire way to ensure appropriate payment. A sequenced, process driven coding cycle is key to optimize collections.

It is best practice to perform frequent code audits.

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