How to Manage Underpaid Orthotics Billing Claims

Running an efficient orthotics billing operation can be a real challenge. Navigating the intricate landscape of orthotics billing can be daunting, especially for smaller healthcare entities. Today, more than 63% of orthotics providers complain of claims being one of their major concerns. To make matters worse, half of their denials are unclaimed which eventually result in revenue losses.

Understanding Denial Management in Orthotics Billing

Denial management involves the process of identifying, appealing, and resolving denied or underpaid claims from insurance providers and governmental payers. Denials can occur due to various reasons, including –

  • Coding errors
  • Incomplete documentation
  • Coverage issues, and more

These denials not only impact the financial health of healthcare providers but also disrupt their operations and hinder patient care. This is why it is essential to overcome the challenges associated in orthotics denials.

Challenges in Denial Management

One of the primary challenges in denial management is identifying the root cause of denials. This often requires a thorough review and analysis of billing data to pinpoint coding inaccuracies, documentation deficiencies, or policy discrepancies. Additionally, appealing denied claims can be a time consuming and resource-intensive process, requiring extensive documentation and following up with payers.

Tips for Effective Denial Management

  1. Regular Review of Fee Schedules: Stay updated on fee schedule variations among insurers and ensure accurate billing according to the correct fee schedule.
  2. Coding Accuracy: Employ experienced medical coders who are well-versed in the latest coding guidelines to minimize coding errors and reduce the risk of denials.
  3. Verification of Insurance Coverage: Verify patients’ insurance coverage before providing services to prevent coverage denials.
  4. Implementation of a Claims Tracking System: Utilize a robust claims tracking system to monitor claim statuses, identify underpaid claims, and facilitate efficient follow-up on appeals.
  5. Stay Updated on Insurance Policies: Regularly review insurer policies to stay informed about changes in reimbursement rates, coverage, and coding requirements.
  6. Utilization of Automated Solutions: Leverage billing software and electronic health records (EHRs) to streamline billing processes, minimize errors, and automate coding and billing tasks.
  7. Continual Staff Training: Provide ongoing training to staff members to keep them updated on billing practices, coding guidelines, and insurance policies.

It is no secret that effective denial management in orthotics billing is essential for ensuring proper reimbursement and maintaining financial stability. By implementing best practices such as regular review of fee schedules, coding accuracy, verification of insurance coverage, and utilization of automated solutions, we at Sunknowledge ensure streamlining your billing processes and maximizing revenue. Partner with us so you can focus on patient care and other administrative management while we navigate the complexities of denial management with confidence and efficiency.