Prosthetics & Orthotics coverage may be subject to a copay or coinsurance. Authorization is required for various devices and this varies from payer to payer. This is considered a part of the member’s benefits provisions. For Prosthetic & Orthotics devices to be covered, a few of the general billing requirements are:
A prescription from the ordering physician dated prior to delivery date.
Consideration of limitations based on time period within which the item can be covered if supplied earlier.
Appropriate modifiers must be billed, e.g. KX, LT / RT, NU etc.
Coverage of devices also subject to qualifying diagnosis, e.g. orthotic shoes are not covered unless diagnosis states diabetic
Repair, replacement and supplies may be eligible for separate reimbursement
Providing billing services for Prosthetics & Orthotics can be a time-consuming and wearisome affair. 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 devotion to quality and staying updated of all the changes happening in reimbursement regulations and coding & documentation requirements.
With GoTelecare’s panel of highly knowledgeable billing experts, you can rest assured that your orthotics and prosthetics billing is in good, capable hands. Boost revenue with fewer denials and increased accounts receivable collection. Contact us for further details today.
OUR COMPLETE APPROACH TO O&P BILLING
Initial Visit Appointment Setup (done by Practice) Order Entry
Patient Account Creation
Patient’s demographic entry
Prescription information entry
Initial Eligibility Verification
Creation of Insurance verification form
Checking general eligibility and benefits information
and updation in OPIE
Initial Evaluation Appointment (done by Practitioner)
Measurements (If required)
Creation of Evaluation form/Notes/Other Medical Records