Tips for improving your orthotics and prosthetics billing struggles

Posted by William Jones on July 21st, 2023

While orthotics and prosthetics play a crucial role in enhancing and making the lives of patients with mobility problems easy, the billing aspect of orthotics and prosthetics is much more troubled than what is seen. 

On January 17, 2023, a second Federal Register Notice was published that announced 10 additional orthoses that will require a face-to-face encounter and written order prior to delivery as a condition of payment. Therefore, effective April 17, 2023, a total of 63 items are now on the face to face encounter and written order prior to delivery List. 

With all these changes, it is often difficult for many providers to keep track of while managing patient care and hence providers end up messing with the orthotics and prosthetics billing operation. 

In fact, problems in orthotics and prosthetics billing do not end here; you further need to remember- 

  • Importance of Detailed Orders: When prescribing orthotics and prosthetic items, physicians must provide detailed, legible, and written orders. This documentation should include the patient's information, the physician's name, a description of the DMEPOS item, the order date, the start date, and the prescribing practitioner's signature. Failure to have a clear and complete order can lead to claim denials. 

  • Verbal Dispensing Orders: Any verbal dispensing order should be promptly followed up with a written order. The written order should contain all the necessary details about the orthotics and prosthetics item, just like the regular written orders. This practice is vital in avoiding discrepancies and ensuring proper documentation. 

  • The EY Modifier for Claims without Orders: In cases where orthotics and prosthetics claims are submitted without proper order, providers should use the EY modifier, indicating the absence of a qualifying healthcare professional to provide the order. Keeping track of such cases and minimizing their occurrence helps maintain a lower error rate. 

  • Justifying Care through Medical Records: Accurate and comprehensive medical records are essential for justifying the care provided and supporting Orthotics and prosthetics claims. Medical history should include information on co morbidities resulting from amputations, the need for ambulatory assistance, and detailed examination reports of musculoskeletal and neurological conditions. 

  • Proper Use of HCPCS Codes and Orthotics Procedures: Correct coding is crucial in orthotics and prosthetics billing. The HCPCS codes and orthotics & prosthetics procedures, along with modifiers, must match the description in the physician's notes. Attention to detail in coding ensures that claims are correctly processed and reimbursed. 

  • Medicare Coverage for Repairs and Replacements: Medicare covers repairs and replacement parts for orthotics and prosthetics items, but it only reimburses 80% of the approved amount for purchasing the DMEPOS item. Providers must maintain proper documentation to justify the necessity of repairs and replacements. Specific codes, such as L7510 and L4210, are used for repairs to prosthetic and orthotic devices, respectively. 

  • Common Errors Leading to Denials: A review by the American Orthotic and Prosthetic Association National Assembly identified higher error rates for lower limb orthoses and lower limb prostheses claims. Errors often stem from insufficient or inaccurate medical records, especially when it comes to replacement records. 

This is why today having a complete understanding and awareness of accurate billing for orthotics and prosthetics is vital for healthcare providers to receive rightful reimbursements for their services; which Sunknowledge can help. 

Sunknowledge - catering to all your orthotics and prosthetics billing needs: 

 

 Avoiding errors in DMEPOS billing, Sunknowledge for the last 15 + years has been delivering state-of-art solutions. ensuring detailed and legible orders, proper documentation of medical history, adherence to HCPCS codes and modifiers, and maintaining records for repairs and replacements, Sunknowledge expert further ensures 100% timely claims submission, constant follow up and better reimbursement. offering you dedicated resources for all closing all your billing needs faster and more efficiently, partnering with Sunknowledge means 80% operational cost reduction, 99.9% accuracy rate and the highest productivity metrics in the industry. 

Following every billing guideline and ensuring smooth and efficient billing processes Sunknowledge ultimately improves your ROI and finally patient care and management. 

Looking for more information on the other benefits that Sunknowledge can provide, call the expert now over a 'no commitment call'. 

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William Jones

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William Jones
Joined: May 7th, 2019
Articles Posted: 93

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