How To Authenticate Orthotics and Prosthetics Billing

Ensuring quality checks and balances and a comprehensive prior authorization process that validates the insurance coverage is critical in orthotics and prosthetics billing. As a DME provider, it will also be important to reduce billing costs by managing denials with a proven methodology.

A company that provides services in medical billing, your first step should be to seamlessly work as a transparent financial extension. Also, it is important to note that in a number of cases the coverage required for orthotics and prosthetics billing is subject to co-pay or coinsurance as well.

It is pertinent to follow some functional best practices especially in general billing requirements that will set the tone for determining the coverage in orthotics and prosthetics. It is vital to a medical billing company to provide quality support with an end to end revenue cycle management strategy.

A clear roadmap with disciplined planning on aging accounts, adjusting the process gap will be the key to making the financial reimbursements consistent in the long run.

It is important to note that every provider today in the DME segment will surely prefer a vendor that upgrades financial mapping. Insurance claims processing, especially in the segment of orthotics and prosthetics, will be requiring an excellent eligibility verification and authorization process. It will help a provider reduce the countless hours and money wasted with faulty claims submission.

Some of the areas that any provider will need expert intervention will be in the use of the appropriate modifiers like the use of RT, NU/KX, LT etc. A proper prescription that shares complete information from the ordering physician has to be processed correctly prior to the date of delivery. Also, a critical area will be to consider the limitations that are based on the time periods and understanding the items that can be covered if supplied earlier.

Qualifying the diagnosis that goes with the coverage mandates is also significant. Also, separate reimbursements with repair, supplies, and replacement are an extremely important contributor to improved orthotics and prosthetics billing.

A disciplined understanding of payer claims adjudication and staying ahead of time in reimbursement regulations is the cornerstone of success if you are a company looking to convince with your medical billing services. Providers will be looking for your capability and exposure in functional best practices that will help them transform their DME billing needs.


Leave a Reply