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 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.
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 this funding for three to six months.
Transform Your Orthotics Billing and Prosthetics Billing With us
Sunknowledge has a highly capable team of DMEPOS billing experts who can make life easier for you from the very first day. With Sunknowledge by your side, you can leave all your Orthotics and Prosthetics billing worries to expert care. Outsourcing your billing requirements to us will allow you and your staff to concentrate on marketing, growing and running business operations, rather than managing a billing and collections department.
Our experience shows that the process for DMEPOS billing can be cumbersome due to its inherent nature, viz. the order getting generated from a physician’s office. This increases complications and the turn-around time as dependencies increase. DME, Orthotics and Prosthetics Billing companies need to devote much time coordinating and communicating with the ordering physician’s office for a valid Rx, medical/therapy notes, etc. Equipment that requires prior authorization also involve innumerable follow-up calls. This is managed effectively by us through our methodical and streamlined process that tracks each request in detail ensuring timely follow-up. Payer guidelines are specific to diagnosis and a thorough knowledge of this result in drastically reducing denials.
Our diligent physician and payer follow-up activities also help reduce turn-around time and improve cash flow. The process starts with entry of orders and ends when the account has zero balance. This includes conducting eligibility checks, obtaining authorization, creating sales orders, scheduling delivery, submitting claims, managing rejections and denials, and proactively following-up AR.
Our List of Services in Orthotics and Prosthetics Billing:
♦ Rx Order Entry
♦ Patient demographics & insurance entry
♦ Product Code/Rx & Dx Entry
♦ Eligibility verification/Authorization
♦ Collection of complete Rx
♦ Collection of documents for Auth approval
♦ 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
- Reduction of Operational Cost by 70%
- 100s of excellent client references
- Highest Productivity Metrics in the industry
Know more on 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 2% 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.