Total Practice Management Solutions in Orthotics Billing and Prosthetics Billing

What is Orthotics billing?

The process of billing for braces, support, or even a splint which is used to support, prevent, or align the movable parts of the body. Some commercial insurance will pay for braces, supports while many will not. It falls under Medicare Part B which covers 80% of the approved costs of custom made / pre-made items of Orthotics billing.

What is Prosthetics billing?

Similarly, the prosthesis is an artificially made limb or a part of the body which is used to replace a part that is missing due to amputation or development. Billing for such items is termed as Prosthetics billing.

How Can We Help?

Transform your Revenue Cycle with our legendary support at just $7/hr.* (all inclusive) guaranteed locked-in rate till 2026!

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How does the process work for Orthotics billing?

The entire workflow involves Rx order entry, patient demographics as well as insurance entry, product code /Rx/Dx entry, checking the eligibility and verification process, collections of the complete Rx, document collection for approval of authorization, submission of claims, management of denials, following up on A/R and payment posting. All of this falls under Orthotics billing.

How does the process work for Prosthetics billing?

It involves the same process, with order intake, checking the eligibility, getting the documents from the doctor’s office on time, prior authorization, order confirmation, and scheduling the delivery. Also, post billing activities with denial management accounts receivable collections and payment posting.

Taming the orthotics and prosthetics Billing Beast: Why Orthotics Practices Need Outsourcing 

Navigating the intricacies of orthotics billing can be like climbing Everest without a guide. Even seasoned practices struggle with the complex coding and ever changing regulations specific to this field. But worry no more, as we are here to help. In fact, outsourcing your billing can be quite helpful for you to reach the summit of financial success. 

Here’s why outsourcing is a game changer for your orthotics practices : 

Expertise you can’t build overnight: Trained coders with laser focus on prosthetics ensure accurate billing and maximize your reimbursements. Say goodbye to denials and hello to happy bank accounts!

Time is money, and you’re losing both: In-house billing takes away precious time from patient care. Let the pros handle the paperwork while you focus on what you do best – healing.

Don’t get lost in the orthotics billing compliance maze: Keeping up with ever changing regulations is a full time job. Outsourcing partners navigate the complexities, saving you from costly penalties.

Technology to the rescue: Leverage cutting edge billing software and automated processes to streamline your workflow and boost efficiency.

Data-driven insights for informed decisions: Get regular reports on productivity, quality, and revenue opportunities, empowering you to make strategic choices for your practice.

So you can forget challenges in orthotics billing like –

  • Stress over coding errors or claim denials.
  • Trouble in revenue flowing in, boosting your bottom line.
  • Peace of mind knowing your billing is in expert hands.
  • Patient care and building meaningful relationships.

A Nationwide Leader in Orthotics Billing and Coding: Your Trusted Partner for Success 

In short, Sunknowledge isn’t just another medical billing company. We’re a nationwide network of experts, spanning across all 50 states and serving a diverse range of healthcare providers, including hospitals, physician practices specializing in orthotics, and even other billing companies. 

Our team boasts extensive experience in the complex world of orthotics billing and coding. Our certified coders are masters of ICD -9 / 10, CPT, and HCPCS guidelines, adhering to the strictest standards set by CMS and AMA. With over a decade of dedicated expertise in orthotics alone, we have a proven track record of success in navigating the intricacies of this field. 

But what truly sets us apart? It’s not just our knowledge or experience, but our commitment to your success. We go beyond simply processing claims; we become trusted partners, working collaboratively to optimize your billing processes and maximize your revenue. 

The Sunknowledge advantage in Orthotics Billing & Prosthetics billing

The biggest advantage that Sunknowledge offers is the unique competence of offering both pre and post billing support and that too on a dedicated basis with flexible communication standards.

Among other things, it requires in-depth knowledge of reimbursement guidelines of Medicare, Medicaid, and Commercial Plans, and their caveat. It also requires a constant adherence to quality and staying abreast of all the changes happening in reimbursement regulations and coding & documentation requirements.

To add to the problem, there are rejections, denials, and cases involving inaccurate billing or erroneous invoices. It’s no wonder that getting paid for these services can be a nightmare!

The Advanced & Accelerated Payment Program is indeed a huge boost and Medicare will be extending emergency funding to DMEPOS providers. Medicare PART B providers can avail of this funding for three to six months.


Transform Your Orthotics Billing and Prosthetics Billing With us

Sunknowledge has a capable team handling all your Orthotics and Prosthetics claims. We do all the heavy lifting work at the front end that makes all your life easier from the first day itself. We help you focus on your patients, outsource all your worries to us as we deliver you actionable support.  With an extensive experience, versatile presence our team makes sure that all your accounts are chased irrespective of their size or source.

We set the perfect benchmark at the onset, with streamlined front-end efforts like checking the eligibilities, communicating with the physician’s office for a valid Rx, collecting all the medical therapy notes, and scheduling the delivery of the equipment. It sets the tone for the submission of cleaner claims that makes way for lesser denials and improved collections.

At these testing times, with a lot of suppliers under huge stress with a lack of workforce, we know what consistency means. Even in this trying situation, we will be delivering you the highest productivity metrics that will eliminate all your practice management worries once and for all.​

Our List of Services in Orthotics and Prosthetics Billing:

♦ Rx Order EntryOrthotics and Prosthetics Billing
♦ Patient demographics & insurance entry
♦ Product Code/Rx & Dx Entry
♦ Eligibility verification/Authorization
♦ Collection of complete Rx
♦ Collection of documents for Auth approval
♦ Submission
♦ Rejection/denial management
♦ A/R Follow-up

Orthotics Billing and Prosthetics Billing Process Highlights

Orthotics and Prosthetics items are subject to copay or coinsurance. Authorization is required for various devices and this varies for different payers.

It is considered to be a part of members benefits provisions.

For the Prosthetics & Orthotics devices to be covered, the general billing requirements are:

  A prescription from the ordering physician dated prior to the delivery date
  Consideration of limitations based on the 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
  Appropriate modifiers must be billed
  Letter of medical necessity and additional documentation may be required for some devices, e.g a PPR form for prosthetics devices, a Diabetic verification Form for diabetic patients, etc. Coverage for such equipment is subject to medical review by the payer.
  The coverage of the devices is also subject to qualifying diagnosis e.g orthotics shoes not covered unless the diagnosis states diabetic
  Repair, replacement, and supplies may be eligible for separate reimbursements

Here’s what you can expect when you choose Sunknowledge : 

  • Nationwide reach and diverse experience: We understand the unique challenges and opportunities across different states and healthcare settings.
  • Unparalleled expertise in orthotics: Our team has the in-depth knowledge and experience to handle even the most complex cases.
  • Data driven approach: We leverage data to identify areas for improvement and optimize your billing processes for efficiency and accuracy.
  • Collaborative partnership: We work closely with you to understand your specific needs and goals, tailoring our services to deliver exceptional results.

Our dedicated Orthotics billing experts are committed to minimizing claim denials and maximizing reimbursements. Through meticulously designed processes, we streamline billing procedures, reducing turnaround time without compromising accuracy. Leveraging state-of-the-art technology and a data-driven approach, our team is dedicated to enhancing revenue streams and reducing denials. Our expertise spans a wide spectrum of Orthotics specialties, including but not limited to foot and ankle surgery, hip and knee surgery, shoulder and elbow surgery, trauma surgery, general orthotics, orthotics oncology, spine surgery, bone health center, hand surgery, pediatric orthotics surgery, sports medicine, osseointegration clinic and more.

So don’t settle for just any medical billing company. Choose the partner with the proven expertise, nationwide reach, and dedication to your success in orthotics. With our comprehensive Orthotics billing solutions, you can trust us to optimize revenue, minimize denials, and ensure seamless operations for your practice. Outsourcing your orthotics billing to Sunknowledge is not an expense; it’s an investment in your practice’s future. Stop climbing alone, partner with a trusted billing expert like us and reach new heights of success!

Sunknowledge guarantees:

  • Reduction of Operational Cost by 70%
  • 100s of excellent client references
  • Highest Productivity Metrics in the industry

Know more about our business synergy approach in Orthotics and Prosthetics billing. Our experts will love to give a tour on how we can serve you with unparalleled productivity standards and consistency.

We welcome you to explore our widely acclaimed range of solutions crafted especially for healthcare service providers just like you. We will be glad to offer you our powerful yet cost-effective services to help you take your business to the next level of success.

FAQ’s on Prosthetics & Orthotics Billing

How are You With front Office Work?

Our team has a perfect understanding of pre-billing work for Orthotics. Right from eligibility verification, getting the authorization approved on time, collecting the documents, and doing it all till the delivery schedule of the item.

How do You Set The Benchmark with Post Billing?

We offer support in denial management, deliver actionable support in accounts receivable collections. We work in eliminating challenges with regular follow up, working on your high-value accounts, and streamline your Orthotics post billing services.

What are Your Credentials in The Orthotics Billing Space?

As a next-gen RCM services partner, we have been working with some of the biggest names in the Orthotics billing space. Our team is equipped with both pre and post Orthotics billing and offers unmatched support to over 100’s of companies in the Orthotics space.

Do You Know about my Software?

Yes, we have excellent versatility in working across all major software systems used in the Orthotics billing space. Also, we have the unique capability of working with any of your proprietary systems and offer a transition approach for understanding your protocols.

What are Your Compliance Standards?

We are a 100% HIPAA compliance destination and with our cutting edge standards, we have unparalleled standards with handling of PHI or any sensitive information. We are a complete orthotics billing services destination.

What are Your Rates?

Our team delivers support at 1.49% of Collections and has the proficiency of working across all practice management systems. In excellence we trust!

What are Your Standards with Communication?

We offer seamless standards of communication, dedicated support with account management. Our team delivers actionable support and work as your reliable operational arm.

Do you Offer Customization?

We have settled standards with customized reporting, understanding your weekly, daily and monthly reporting practices and make sure we work as an extension of your operations.

What are Your Contractual Obligations?

We have a no binding contractual policy and also offer complete support for any errors of Omission & Commission with a liability cover of $1/$3 million from Hiscox/Geico.

To find out more about how we can help you, simply fill out the form below and send it to us. Whether you are looking for more information or wish to receive a free, no-obligation consultation, we are waiting to hear from you.

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