Prosthetic Billing Outsourcing: Why It Matters
Prosthetic billing outsourcing is a fairly common practice among healthcare providers, orthopedics, and DME vendors. The basic reason is the inability of internal staff to handle the typical billing of prosthetics and orthotics. Often subject to copayment and/or coinsurance, coverage for orthotics and prosthetics has different requirements for various devices and varies by payer. This must come within the member’s benefit provisions. A denture biller has a lot to do. That includes:
• Pick up the prescription from the doctor who orders it with a date prior to the delivery date.
• Consider the limitations of the covered item according to the fixed time period. Example: Medicare covers one pair of orthopedic shoes per calendar year.
• Bill appropriate modifiers.
• Consult letter of medical necessity and additional documentation required for some devices. Example: PPR form for prosthetic devices.
• Check the coverage of devices subject to qualifying diagnosis.
• Consider repair or replace and supply for separate reimbursement based on eligibility.
Most providers, orthopedic companies, and DMEs find that their billing staff spend a lot of time countering these operations, which turn out to be quite time-consuming and onerous, since they are already packed with various responsibilities. Add to this in-depth knowledge of Medicare, Medicaid, and commercial plans reimbursement guidelines, their warning, etc. necessary to perform these jobs expertly. Operational inefficiency in these areas directly impacts cash flow as claim denials increase and receivables collection suffers. This is why you should consider prosthetic billing outsourcing.
Prosthetic Billing Outsourcing: How It Helps
A reliable medical billing service offering prosthetics (and orthotics) billing solutions will provide you with a number of features including:
Eligibility Verification
• Check the active Policy for a date of service
• Verify entry of copay/coinsurance/OOP, Rx and Dx
• Check supplier status
• Check authorization requirement
• Obtain authorization
Authorization check
• 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 control
• Communication with the doctor’s office for any additional medical documentation and clarification required
Accounts Receivable Analysis
Accounts Receivable Analysis
Follow up with payment
Closing of claims
Denial Management
• Correction of claims
• Forwarding
• Patient Responsibility
However, you must be very careful to find a billing partner that can handle your prosthetic billing needs within your budget and provide you with a comprehensive revenue cycle management/practice management solution.