Sharpen your Awareness of Orthopedics and Orthotics Billing Intricacies

It is often seen that people mostly get confused between orthotics and orthopedics as they both sound similar. However, they serve very different purposes in the realm of medicine. Let us delve into the subject to distinguish between the two to provide better clarity.

Understanding the Basics of Orthopedics and Orthotics Billing

The Orthotics domain specializes in devices designed to support and stabilize weakened or injured body parts, particularly joints. They aid in proper alignment, relieving pressure and managing pain. On the other hand, Orthopedics is a medical specialty that focuses on the diagnosis, treatment and prevention of conditions related to the skeletal system and its connecting parts, such as bones, joints, and tendons.

When discussing Orthopedics, there is a common question that is encountered on a daily basis is when it comes to medical procedures, is there any common or overlapping area for both the specialties. It is important to note that while all orthopedic surgeons are specialists in Orthopedics, not all orthopedic specialists perform surgical procedures. Also, orthotics practitioners, commonly known as orthotists, typically hold a Master’s Degree in prosthetics and orthotics.

Further, Orthotics is mainly divided into two categories viz. mass-produced and custom-made. Mass-produced Orthotics are relatively affordable and readily available without a prescription, and do not require a visit to an orthotist’s office. Custom-made orthotics can be more expensive, may not be fully covered by insurance, and usually necessitate a prescription from a Physician, Physician’s Assistant (PA), or Doctor of Physical Therapy.

All About Orthopedic and Orthotics Billing

Understanding the fundamentals of both the specialties is extremely crucial for medical practices in these fields. Orthopedic practices commonly encounter claim denials due to factors such as duplicate claims and service charges exceeding fee schedules, among others. However, these issues can be mitigated through preventive measures such as ensuring accurate patient information collection, diligent insurance verification, and utilizing automated billing services.

Recent changes in ICD-10 coding have impacted all medical specialties, including Orthopedics. These changes emphasize the importance of documenting factors such as laterality (right, left, or bilateral), site specificity, place of occurrence of injuries, and type of patient encounter (initial, subsequent, or sequela).

Similarly, Orthotics billing involves a comprehensive workflow that includes Rx order entry, recording patient demographics, insurance entry, product code/Rx/Dx entry, eligibility verification, claims submission, denial management, and payment processing. Compliance with reimbursement guidelines from Medicare, Medicaid and commercial Plans, however, is essential for both Orthopedic and Orthotics billing.

If you are considering outsourcing your medical billing, it is crucial to partner with a reputable, HIPAA-compliant billing service provider. Such RCM experts not only stay abreast of changes in the healthcare landscape, but further offer expertise in medical billing and coding, ensuring timely payments and accuracy in billing processes. Sunknowledge is such a partner. Today, it has earned a reputation of being the trusted RCM partner for many leading orthotics practices across the nation by dint of its high productivity metrics and accuracy.

If you are looking to know more about how our experts can make a difference in your Orthotics billing, get in touch with us over a ‘no-commitment’ call today.