Orthotics and prosthetics care facilities are always grappling with meeting Medicare requirements to achieve adequate revenue. Equipment or support can be of two types, one medically necessary and the other out of preference. This is the reason behind the complexity of orthotics and prosthetics billing.
Dealing with these intricacies is crucial to streamline the process and lead to a better bottom line. Healthcare providers must focus on financial stability while devoting their time to patients.
For this, they must opt for effective ways to minimize errors in orthotics and prosthetics billing. Although handling administrative tasks is difficult, healthcare providers can get assistance from medical billing services.
This blog introduces the topic of orthotics and prosthetic billing and explains common shortcomings, crucial guidelines, and how healthcare providers can address the issues.
Understanding Orthotics & Prosthetics Billing
Orthotics and prosthetics billing is somewhat similar to Durable Medical Equipment as it comes under Medicare Part B. However, this is a different specialty, and the challenges are varied as well.
To be specific, orthotics include support of the movable parts of the body such as braces, splints, etc. It also includes tailor-made and pre-made items and around 80% of items are approved under Medicare Part B.
Prosthetics are more serious as they are artificial extensions for the body such as limbs or hands. It is meant to replace the missing or amputated body part. The medical billing for orthotics and prosthetics is done separately.
As a result, the terms and conditions do change depending on the item. The medical billing process is the same as the other medical billing specialties, only the revenue depends on prescription, diagnosis, and delivery.
Common Shortcomings in Orthotics & Prosthetics Billing
The major thing that pulls orthotics and prosthetics billing down is the drawbacks in the documentation. Further, these errors result in denials, if not treated within time, then they lead to subsequent revenue leakage.
Most shortcomings in the medical billing process are interrelated and need a comprehensive approach to improve and optimize.
Let’s understand how different challenges affect the healthcare administration:
Documentation Errors
The most common errors occur in lower limb orthotics, due to inaccuracies in medical records. On the other hand, errors in limb prosthetics happen due to inaccuracies in records of replacement.
Healthcare providers must document descriptions of all items with complete details such as item type (orthotics/prosthetics), patient’s demographic data, date of order placement, prescriptions, and delivery of items.
The documents must also specify the severity of the patient’s diagnosis and comorbidities.
Frequent Denial of Claims
Managing the denial rate and taking measures to promote a clean claims rate is essential to maximize reimbursement. Frequent denials are not a good sign for the profitability of the orthotics and prosthetics facility.
Time is the most important factor in reclaiming the lost revenue. In orthotics and prosthetics, billing appeals must be filed within 120 days. Having proper denial management to prevent denials in the first place and recover the denied claims can help a healthcare practice in optimizing revenue cycle management.
Coding Complexities
Even though documentation is vital, healthcare providers must always remember the significance of coding. Coding errors also lead to claim denials and avoiding coding complexities is another major aspect of improving the bottom line.
Coding for both orthotics and prosthetics must meet the HCPCS coding guidelines. Matching the treatment with accurate codes is essential to achieving adequate revenue and eliminating denials.
Repairs and Replacements
An additional aspect of orthotics and prosthetics billing is the occurrence of repairs and replacements. This is the main reason behind medical billing complexity as coding for these factors can be confusing. The documentation must justify repairs from them to get reimbursed. Other than that, healthcare providers must also have complete knowledge of specific codes for repairs and replacement.
It is easy to make mistakes in this and that is why extra attention is needed to achieve positive results.
Crucial Guidelines to Follow in Orthotics & Prosthetics Billing
Taking care of essential guidelines can save healthcare providers from making some common mistakes and losing revenue. Here is the list of things you should ensure in your orthotics and prosthetics practice:
- The first and foremost is ensuring the date of prescription and the date of delivery. The date of prescription must always be before the date of delivery.
- The second is not missing out on modifiers and taking all measures to ensure their accuracy as they are billed.
- Remember that many items are covered within a time frame, and you must renew the terms based on limitations. For illustration, orthotic shoes are eligible for reimbursement every calendar year under Medicare.
- It is necessary to prove the medical necessity for items and provide additional documentation for the same.
- Insurance coverage is also vital to move the process from diagnosis to delivery of the device.
- Healthcare facilities can get separate revenue for the repair and replacement of orthotics or prosthetics devices.
Tips to Improve Orthotics & Prosthetics Billing
After getting a detailed idea of orthotics and prosthetics billing, we have reached the part where we will discuss how healthcare providers can deal with complexities and improve the billing process for better reimbursement.
Healthcare providers need a streamlined administrative process and for this, they require skill and knowledge. One thing even more important than expertise is time to perform the medical billing process.
Medical billing services can seamlessly solve this issue for healthcare providers. They can deal with intricacies and lead to efficient medical billing free from errors.
Outsourcing orthotics and prosthetics billing can be groundbreaking for healthcare practices. Let's learn some advantages of outsourcing medical billing services:
Orthotics & Prosthetics Billing Expertise
Expertise is essential to ensure accuracy and efficiency in medical billing. Outsourcing companies work with qualified coders and billers who provide skillful services to eliminate errors and improve revenue cycle management.
More Time to Focus on Patient Care
Healthcare providers have limited time and due to this, they struggle to maintain a balance between rendering patient care and handling administrative tasks. With medical billing services, orthotics and prosthetics centers can focus on providing quality patient care, where medical billing is handled by experts.
Comprehensive Regulatory Compliance
Outsourcing partners care about their reliability and that is why they help healthcare providers in achieving complete compliance. They help in keeping patient data safe from misuse by meeting the compliance standards of HIPAA. Other than that, they also help in achieving other important coding compliances.
Technological Advancement
Expert medical billing services utilize new and advanced technologies to streamline time-consuming administrative tasks. This helps in preventing human errors such as negligence and missing details.
Insights for Better Management
Outsourcing partners have a greater understanding of how medical billing works. This also makes them eligible to identify the shortcomings in already existing operational management. They give healthcare providers a clear insight into medical billing performance. Using this data, healthcare providers can improve the medical billing process by taking corrective actions.
Bottom Line
Orthotics and prosthetics billing is complex and needs expertise to eliminate errors and avoid denials. However, healthcare providers usually don’t have enough time to handle medical billing and patient care at the same time. Only a comprehensive solution can improve medical billing and optimize the revenue cycle and that solution is medical billing services.
As an orthotics and prosthetics provider, you will no longer struggle to keep up with the frequently changing medical billing landscape with professional services.
Eminence RCM is proficient at orthotics and prosthetics billing. With a team of proficient medical billers and coders, you can successfully eliminate the intricacies and achieve adequate revenue. Moreover, your healthcare practice will not face the issue of non-compliance with essential regulatory standards.
The team takes care of all vital aspects of orthotics and prosthetics billing. Your practice also benefits from advanced technological tools to eliminate coding errors and mistakes in recording and documentation. At Eminence, proper denial management is ensured to prevent the healthcare practice from any type of revenue loss.
With Eminence RCM, you will reach your goal of attaining financial stability while optimizing operational management.
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