How to Reduce Errors in Orthotics & Prosthetics Billing

The most talked-about industry is—healthcare—and its total expenditure were estimated to be $3.24 trillion in 2015, and are projected to soar to $3.78 trillion in 2018. To address this hyper-competitive environment, healthcare outsourcing companies are introducing outstanding strategies to render streamlined services for their esteemed clients.

To cater to Orthotics & Prosthetics billing supreme expert’s supervision is needed to reduce errors. The human support mechanisms—Orthotics & Prosthetics— needs an extra care while billing for its products.

When, you start to face revenue loss, it is time to improve Orthotics & Prosthetics billing operations. Errors in billing are a strict no-no. Orthotics & Prosthetics coverage may be subject to a copay or coinsurance and authorization is required for various devices and this varies from payer to payer. This is considered a part of the member’s benefits provisions.

For error free billing, one should adhere to these guidelines:

  • A prescription from the ordering physician dated prior to delivery date
  • Appropriate modifiers must be billed
  • Consideration of limitations based on time period within which the item can be covered if supplied earlier. E.g. A pair of  Orthotics shoes are covered per calendar year by Medicare
  • Letter of medical necessity and additional documentation may be required for some devices, e.g. PPR form for prosthetic devices, Diabetic Verification, and Form for diabetic patients etc.
  • Coverage for such equipment is subject to medical review by the payer

The must-haves components of Orthotics and Prosthetics billing are:

  • Patient demographics & insurance entry
  • Provider information entry
  • Product code, Rx & Dx entry
  • Eligibility verification and authorization requirement enquiry
  • Rejection & Denial Management
  • A/R follow-up
  • Creation of claim after receipt of confirmation of delivery
  • Submission of EDI/paper claim to Payers

Communication is the key to all billing procedures and Orthotics & Prosthetics is no exception. To avoid errors, billers need to be very confident and ensure the necessity of a procedure and accuracy of the reports they receive, prior to billing. Operational efficiency says it all, to understand the value of billing in Orthotics & Prosthetics outsourcing.

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