How Orthotics & Prosthetics Billing Services are Helping the Healthcare Industry?

Just when the DME sellers, hospitals, and other providers in the healthcare domain are reeling under the medical billing pressure due to regulatory changes and the aftereffects, the presence of the professional orthotics and prosthetics billing services have provided them with a huge respite. 

Outsourcing the billing functions of your practice to professional orthotics & prosthetics billing services is highly advisable as the expertise and experience it will bring to your practice is unlikely to be found with your in-house staff. The skilled and dedicated billers of the outsourced services help you in the turnaround by boosting the revenue better handling of claim settlements and reimbursements. 

Orthotics & prosthetics billing is often featured by the copays and/or coinsurances in a number of cases.  The coverage demand as per requirement of various devices according to different payers is another glaring characteristic of  prosthetics & Orthotics billing. Of the several functions that the prosthetics & orthotics billing executives to take care, the main are:

• Collecting prescription from the ordering physician, this should be dated prior to the delivery date.
• Keeping track of the limitations of the covered-item based on the designated time period. 
• Billing the appropriate modifiers.
• Checking the required documentation.
• Checking the qualification of coverage according to the type of diagnosis.
• Considering the reimbursement eligibility for repair/replacement/supply. 

Apart from the above points, leading medical billing companies offer a host of solutions to your prosthetics & orthotics billing process. These services give a holistic solution to the process starting from analyzing, identifying the basic problems, addressing those to provide a customized solution. The regular billing functions are taken care of it. Let’s take a quick look at the regular billing functions of the prosthetics & orthotics billing services:

Eligibility Verification Functions: 

• Checking the active date of service of the policy

• Check if there’s a Co-pay / Coinsurance / Owith OP, Rx & Dx entry 

• Check the status of the provider  

• Check requirement for authorization

• Arrange to obtain authorization

Authorization verification Responsibilities:

• The follow-up to resolve and closure

• Periodical follow-ups 

Coding Functions:

o Place of Service Based Coding including Inpatient and Outpatient Coding

o Provider Specialty Based Coding that includes E/M, Cardiology, Orthopedics, Physical Medicine, etc. 

o Assignment of proper diagnostic ICD-10 codes

o Assign applicable modifiers 

o Review code for quality assurance

o Communicate with Physician’s office in case any extra medical documentation and/or  clarification is required

Apart from these the Orthotics & prosthetics billing services perform functions like accounts receivable analysis, claim correction, resubmission, etc.