- July 25, 2022
- Posted by: Steve Smith
- Category: Orthotics Billing
Understanding Coding Challenges in Orthotics billing
Billing for orthoses is an area of concern for most of those engaged in the general area of orthotics & prosthetics. This is especially true for O&P providers because, more often than not, the onus of getting paid for services rendered rests squarely on their shoulders. In a cash-only practice, such concerns would not have existed. But that is not the reality. A modern day practice must recover costs from the patient’s insurance plan. And this entails formulating and submitting a formal claim for reimbursement.
Herein lie some of the biggest challenges of Orthotics billing. Drafting a ‘perfect’ claim – one that is complete, accurate and will not be turned down by the insurance payer – requires a high degree of precision and exact knowledge of billing norms and procedures. And of these, understanding coding caveats is of top importance. For example, it is critical for a practice to be able to distinguish between CPTs and L codes, or to understand what Insurance Company A will pay for that Company B will not.
There are other matters to consider, too. One must be careful to code and bill right-foot and left-foot orthotics on separate claim form lines with the appropriate code, accompanied by the correct “-RT” or “-LT” modifiers. It is a good practice to check back with the provider in case the codes provided are found to be insufficient in accurately describing the orthotic work done for the patient. It would be unwise to assume a catch-all or unlisted code (such as the CPT 29799—unlisted casting code) could be used discriminately, especially where a more appropriate code exists.
The need for Expert Assistance
Coding slips can lead to missed earnings and revenue loss. And if they are too frequent, the effect on profitability can be a bad one. Providers, of course, understand that, and try to get good billers and coders to work for them so that such losses can be minimized. However, expertise comes with a price tag, and very often, it’s a steep one. In a bid to keep staff-cost down and yet get the best results in billing & coding, a growing number of Orthotics & Prosthetics practices are choosing to outsource their billing operations to specialized, third-party service providers. Strategic outsourcing of key billing activities to specialized, offshore billing experts can work wonders in drastically bringing down operational cost while allowing providers to enjoy top quality results minus all the usual hassles.
The greatest advantage of engaging a dedicated billing agency is that providers can instantly tap into a vast pool of skilled billing personnel at a cost that is significantly lower than the pay demanded by regular, in-house staff. And along with exceptional cost savings, having dedicated, professional assistance brings about an overall improvement in the entire revenue cycle, especially in the rate of collections. Denial rates are also noticed to drop sharply, with more bills getting passed than before. This is all due to fewer coding errors or otherwise, a natural advantage when you have dedicated and experienced personnel working for you.