“Handling the complex and lengthy process of orthotics billing with expertise of qualified professionals”
In general, orthotics are shoe inserts or ankle braces for different conditions of the foot and ankle. But when it comes to medical billing it becomes a part of durable medical equipment. Orthotics is an essential part of DMEPOS as it provides therapeutic benefits to the patients.
To be more precise, they are artificial corrective devices to support weak or deformed parts of the body customized for patient needs. These details add to the complexity of medical billing making it hard for orthotics providers to receive due reimbursement.
Anyways medical billing is a complicated task but in the case of orthotics, providers need to be extra careful. All this is due to specific features of insurance coverage. For custom foot orthotics, insurance depends on individual policies where orthotics may not be a part of it. Facing these challenges becomes necessary to attain complete revenue but they are also the sole reason for stress related to medical billing.
With challenges comes the responsibility of handling orthotics billing efficiently, which an outsourcing company can manage effortlessly. Understanding the basics of this specialty is a must to perform the functions of the medical billing process. This blog is a complete guide on orthotics billing that will give you all the valuable insights needed to obtain a streamlined financial posture.
Orthotics Medical Billing and Coding
Orthotics is a fundamental part of podiatry and revenue generation relies on fixed service charges. When these charges are not received on time then it creates financial constraints for the healthcare practice. Without extensive knowledge of insurance coverage standards and eligibility conditions, healthcare providers face difficulties in getting complete reimbursement. Medical billing and coding are an essential part of your revenue cycle management and to maintain the flow of operational efficiency, knowing the billing rules and codes is also important.
All these needs in orthotics medical billing become even more important as patients require custom equipment. Considering the fact that every individual is unique, medical billing also differs in every case.
Steps in Orthotics Medical Billing
Patient Insurance Verification
The first step in the process of orthotics medical billing is patient eligibility verification. Not all the patients have insurance coverage that covers durable medical equipment. Verifying the insurance policy beforehand gives clarity on how to proceed further in case of no insurance coverage. In this step various other information related to patient is also collected and verified to maintain a complete record of patient demographics.
Complete Documentation
Once the eligibility is verified, we move forward to the next step that is documenting for filing the claims. This documentation process includes prescriptions given by the healthcare provider; certificate of medical necessity assigned by the care provider, prior authorization and proof that the equipment has been delivered.
Without this process, we cannot go to the next step as all the major information is recorded here. This is the basis of the claim filing that includes allocating CPT codes for specificity of the specialty.
Confirming Accuracy of Claim Information
Accuracy of claims depends on allocation of codes and modifiers for corresponding orthotics. This confirmation protects the claim from potential errors and mistakes in the medical billing and coding procedure. Here the medical provider must check that HCPCS Level II codes match with the correct orthotics equipment. Along with that, they must check if modifier’s description coordinates with the accurate device.
This step strengthens the base of the medical billing process enabling a better financial flow for the revenue cycle of the practice.
Submission of Claims
The last but not the least step is submission of claims. Without this step, the care providers are not eligible for the revenue they deserve. Submission of claims must be done using appropriate forms to not miss out on any details. The focus must also be on the additional information vital for the process of claim submission.
Other Important Steps in the Process
These were the main steps of medical billing but there are further steps that are as significant as the existing steps and they are:
Account Receivables and Follow up
Even after proper monitoring and analysis before finalizing claims, overdue payments are inevitable. The cycle of AR days begins right after submission of claims, making its prevention even more important. The longer the claims stay in AR, higher are the chances of not getting paid.
Such financial loss is avoidable with proper AR follow up procedure. For orthotics medical billing, AR follow up helps in maintaining positive cashflow. Under this, unreceived or missed claims by the insurer are analyzed to understand the problem and rectify them. Other vital parts of the process are managing, denied claims, recovering overdue payments, providing financial stability and managing pending claims.
Denial Management
Denials are not unusual in orthotics billing but the frequency of claims getting denied can be reduced. This is possible with a comprehensive denial management that analyzes, corrects and takes preventive measures for the future. The things that a denial management checks are the preciseness of claims, misleading claims and untimely filing.
Efficiency of denial management directly corelates with the productivity of the revenue cycle which is extremely vital to eliminate losses.
Partnering with Expert Orthotic Billing Services
Healthcare providers are already under the stress of handling patient care along with medical billing. On top of that, complexities of CPT codes for orthotics only increase the hassle of care providers. For any healthcare practice, reimbursement is most important to keep the practice going. An outsourcing partner can tackle the medical billing process effortlessly taking away the burden from the shoulders of care providers. An orthotics billing partner is well versed with the steps and skills required to master the billing process.
Bottom Line
The specialty of orthotics is dynamic and frequent changes in the guidelines increase the intricacies in the process of medical billing.
Orthotics medical billing if not handled efficiently, can disrupt the quality of practice, making the situation more stressful. However, an outsourcing partner can assure that your claims are accurately prepared and submitted. Unify Healthcare Services provides the best orthotics billing solutions to maximize reimbursement and streamline operational flow. Get error free order creation, insurance verification for rental items and follow-up for the incomplete prescription to improve the collection process.
