How to Measure an Orthotics Billing Process Efficiently

Orthotics plays a vital role, offering effective treatment solutions for various conditions. However, alongside its benefits, there are some financial considerations that practices must bear in mind to ensure the best outcomes.

Ensuring timely collection of fees is crucial to sustaining the financial health of any healthcare practice. In fact, it is imperative that your staff is well-versed in the coverage criteria of major insurance providers commonly dealt with by your office. This knowledge streamlines the process of determining whether orthotics is covered for patients, saving valuable time. For less familiar insurance companies, proactive communication is key to ascertaining eligibility and coverage guidelines.

Also, it is important to note that if orthotics is not covered by insurance, associated services may also be affected. For instance, Medicare typically does not cover foot orthotics unless they are part of a diabetic shoe or brace. Similarly, services like range of motion and muscle testing may not be reimbursed if related to orthotic fabrication, casting, or adjustments. So by proactively addressing coverage criteria, being transparent about fees and establishing clear policies, practices can navigate the financial aspects of orthotic services more effectively, ensuring both patient satisfaction and practice viability.

Additionally, it is not enough to simply state the diagnosis; details about the specific conservative modalities used should also be included. These may encompass shoe modifications, padding, OTC devices, or strapping. When justifying the need for an orthotic device, any ‘medical necessity’ letter should articulate why this particular patient, with their specific diagnosis, requires the device at this time. You should also avoid making generic statements about orthotics, such as their materials or biomechanical theories, unless directly related to the patient’s medical necessity.

When billing for orthotics, it is advisable to utilize two separate lines on the claim form — one for the right foot and one for the left foot. This approach tends to be less confusing for insurance carriers compared to billing a single line with multiple units.

Orthotic dispensing costs are generally included in the overall cost of the orthotic, but it is crucial to be aware of the appropriate billing codes. Orthotic adjustment visits, for instance, do not involve an evaluation and management (E / M) component, whereas follow-up visits to assess treatment progress do.

One common billing mistake in orthotics billing is associating casting fees with L3030 orthotic devices, which are meant to be molded directly to the patient’s foot without the need for a plaster mold. Additionally, distinguishing between L3000 and L3020 codes is important based on the orthotic design, such as the presence or absence of a heel post.

Familiarizing yourself and your staff with all these and the descriptions of different orthotic types is crucial for accurate billing and ensuring that chart notes are aligned with the selected codes. Thus, staying updated becomes very important here on each carrier’s policies regarding orthotic codes to avoid billing discrepancies. So with all this confusion today, the most convenient solution to keep your practice profitable is outsourcing.

Sunknowledge – The Passport to Outsourcing All Orthotics Billing Troubles

Effectively managing orthotics billing requires precision and expertise to ensure compliance and maximize reimbursements. At Sunknowledge Services Inc., we specialize in Orthopedics/DME billing and coding, providing comprehensive solutions to streamline your revenue cycle management. With tailored solutions catering to all your billing needs, we stand out as the top RCM expert, boasting the highest productivity metrics. With over two decades of experience, we excel in navigating the complexities of working with both payers and providers, ensuring optimal outcomes for all your billing activities.

Ready to optimize your orthotics billing? Contact us now to schedule a consultation with our experts. Let us take care of your billing and Practice Management complexities while you focus on delivering exceptional patient care.