Outsourcing billing for prosthetics is a fairly common practice among healthcare providers, orthopedics, and durable medical equipment vendors. The basic reason is the inability of internal staff to handle the typical billing of prosthetics and orthotics. Often subject to a copayment and / or coinsurance, coverage for orthotics and prosthetics has different requirements for various devices and varies by payers. This should be included in the member’s benefit provisions. A prosthetic biller has a lot to do. That includes:
• Pick up the prescription from the doctor who requested it before the delivery date.
• Consider the limitations of the covered item based on the fixed time period. Example: Medicare covers one pair of orthopedic shoes per calendar year.
• Bill appropriate modifiers.
• Check the letter of medical necessity and additional documentation required for some devices. Example: PPR form for prosthetics.
• Verify coverage of devices subject to qualification diagnostics.
• Consider repair or replacement and supply for separate reimbursement based on eligibility.
Most DME providers, orthopedics, and companies find that their billing staff spend a lot of time countering these very labor-intensive and time-consuming operations as they already have multiple responsibilities. Add to it in-depth knowledge of Medicare, Medicaid, and commercial plan reimbursement guidelines, your warning, and more. necessary to carry out these jobs expertly. Operational inefficiency in these areas directly affects cash flow as claim denials increase and accounts receivable collection hits. That is why you should consider prosthetic billing outsourcing.
Prosthetic Billing Outsourcing: How It Helps
A reliable medical billing service offering prosthetic (and brace) billing solutions will provide you with a number of features including:
Eligibility Verification
• Check Active Policy for a date of service
• Check copayment / coinsurance / OOP, Rx and Dx entry
• Check the status of the supplier
• Check the authorization requirement
• Obtain authorization
Authorization verification
• Follow-up until resolution and closure
• Complete the authorization process efficiently
• Follow-up periodically to maintain the validity of the authorization
Medical coding
• Coding based on place of service – Inpatient and outpatient coding
• Coding based on provider specialty: E / M, cardiology, orthopedics, physical medicine, etc.
• Assign appropriate ICD-10 codes for diagnosis
• Assign modifiers as appropriate
• Code review and quality assurance
• Communication with the doctor’s office for any additional medical documentation and clarification required
Accounts receivable analysis
A / R analysis
Follow up with payment
Claims closing
Denial management
• Correction of claims
• Forwards
• Responsibility of patients
However, you need to be very careful when looking for a billing partner who can take care of your prosthetic billing needs within your budget and provide you with a comprehensive practice management / revenue cycle management solution.