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.

Leave a Reply

how can we help you?

Get in touch with our experts on our functional best practices that streamlines your medical billing priorities.

Are You Looking for streamlined medical billing assistance?


Enough of us! Lets know about your areas of interest! Get connected for a quick discussion on how we can elevate your revenue cycle management experience by working as a seamless operational extension.

    Input this code: captcha