Prosthetics & Orthotics Billing – An Industry Insight

Orthotics & prosthetics billing services start where the providers’ in-house billing staffs get restricted - in the ability to address the various prosthetics & orthotics billing issues.

Professional prosthetics & orthotics billing services are in great demand now. The recent regulatory changes like the rollback of Obamacare or the introduction of the Final Rule mandate have left numerous Dme sellers, nursing homes; urgent care centers hospitals and other healthcare providers struggling and forcing them to outsource their prosthetics & orthotics billing responsibilities to medical billing companies for respite. Most providers run by the in-house staffs suffer from their inexperience and lack of skill, resulting in poor handling of prosthetics & orthotics billing functions. This results in unwanted errors in the system, lack of accuracy, improper follow-up strategies, etc. and ultimately more denials and rejections.

The professional medical billing companies score over in these parameters, through their better claim and reimbursements handling prowess, helping the revenue back.

Prosthetics & orthotics needs the specialized attention as it is conspicuous with the presence of coinsurances and/or copays, quite different from other medical billing streams. Another highlight of prosthetics & orthotics billing is the specific coverage demand of different payers for various equipment. The following key activities are the basic areas that the prosthetics & orthotics billing services make the difference:

• Collection of the prescription from the ordering physician
• Take care of the covered-items’ limitations on the basis of designated time periods.
• Bill the appropriate modifiers
• Check the required documentation
• Check the diagnosis based coverage qualification criteria.
• Consider reimbursement eligibility for repair/replacement/supply.

However, prosthetics & orthotics billing services do much more. Reliable billing companies give you a holistic and customized solution to address your prosthetics & orthotics billing issues through systematic analysis and identification of the key issues. Apart from this, prosthetics & orthotics billing services carry out a number of billing functions that include:

Verifying Eligibility

This involves verifications of:

• Policy’s Active date of service
• Co-pay / Coinsurance / OOP, Rx & Dx entries
• Provider status
• Authorizations

Verifying Authorization

This involves the following activities:

• Follow-ups to resolve until closure
• Regular follow-ups with the insurance

Coding Responsibilities

This involves various coding functions like:

• Place of Service Based Coding: Inpatient and Outpatient Coding
• Provider Specialty Based Coding: E/M, Cardiology, Orthopedics, Physical Medicine, etc.
• Diagnostic ICD-10 codes
• Assigning applicable modifiers
• Reviewing quality assurance codes

Other Functions

• Analyzing Accounts Receivables
• Claim Correction
• Resubmissions

Leading medical billing with years of prosthetics & orthotics billing exposures can also address your medical billers and coders staffing issues at the lowest prices in the market. Some also provide your added advantages like free Telemedicine platform with RCM or Practice Management package.

This author is a professional writer and also a blogger. His fields of interest is the Healthcare industries.