All You Want To Know About Custom Orthotics Billing
Most
providers involved in the field of orthotics and prosthetics are concerned
about billing for orthoses. This is especially true for O&P providers
because the burden of getting paid for services rendered frequently falls
squarely on their shoulders. Such concerns would not have existed in a
cash-only practice. But that is not the case. A modern practice must recoup
costs from the patient's insurance provider. This includes preparing and
submitting a formal claim for reimbursement. That’s why it is crucial to know
everything about custom orthotics billing. Here is a glimpse of the orthotics
and prosthetics providers:
Custom
Foot Orthotics Insurance Coverage:
Custom
foot orthotics insurance coverage varies by the insurance company and
individual policy. Always check with the patient's insurance company to see if
foot orthotics are a covered benefit. Often, you will discover that they are
not covered and must be paid for in cash after a lengthy verification process.
If you have out-of-network patients, the best idea is to ask them for cash
payments with a letter of medical necessity and HCFA
to file the claim. Flexible spending accounts and Health Savings Accounts are
two other options that can be used. If the patient is paying cash, inform them
of the services that are included with their orthotic purchase (fitting, follow-up
visits, training, adjusting, etc.).
CPT
CODE #97760 - Examination, Designing, Casting, and Education
HCPCS
CODE L3000 - Foot, removable insert, molded to patient model, 'UCB' type.
(MODIFIER
– Left and Right Foot will be billed separately i.e., L3000RT for the right
foot, L3000LT for the left foot)
HCPCS
CODE L3030 - Foot, removable insert, formed to patient foot, each
(MODIFIER
– Left and Right Foot will be billed separately i.e., L3030RT for the right
foot, L3030LT for the left foot)
CPT
CODE #97762 - Check-in - Dispensing and Fitting
The
patient's health plan benefit language and guidelines will determine whether
these codes are covered (as opposed to a low-level E/M service or no coverage
at all).
Obviously,
if custom foot orthotics are not covered items under a plan, these codes are
ineffective for evaluating those non-covered orthoses. Custom foot orthotics will
not be covered by Medicare.
Custom Orthotics Billing
Challenges:
Drafting
a 'perfect' claim - one that is complete, accurate, and will not be rejected by
the insurance payer - necessitates a high level of precision and precise
knowledge of billing norms and procedures. Understanding coding caveats is the
most important of these. It is critical for practice, for example, to be able
to differentiate between CPTs and L codes, or to understand what Insurance
Company A will pay for that Insurance Company B will not.
There
are also other factors to consider. Right-foot and left-foot orthotics must be
coded and billed on separate claim form lines with the appropriate code and the
appropriate "-RT" or "-LT" modifiers. It's a good idea to
double-check with the provider if the codes provided aren't adequate for
accurately describing the orthotic services done for the patient. It is risky
to assume that a catch-all or unlisted code (such as CPT 29799—unlisted casting
code) can be used discriminately, especially when a more appropriate code
exists.
Expert
Assistance Is Required!
Coding
errors can result in lost earnings and revenue and if they occur too
frequently, the impact on profitability can be negative. Of course, providers
are aware of this and work hard to outsource experienced custom orthotics
billers and coders in order to reduce such losses. However, expertise
comes at a cost, and it's often a high one. A growing number of Orthotics &
Prosthetics practices are outsourcing their billing operations to specialized,
third-party service providers in order to reduce staff costs while achieving
the best results in billing & coding.
Strategic
outsourcing of key custom orthotics
billing activities to specialized, offshore billing experts can work wonders in
drastically bringing down operational costs while allowing providers to enjoy
top quality results minus all the usual hassles. The most significant benefit
of using a dedicated custom orthotics
billing company is that providers can instantly access a large pool of skilled
billing personnel at a much lower cost than regular, in-house staff.
Along
with significant cost savings, having dedicated, professional assistance
improves the entire revenue cycle, particularly the rate of collections. Denial
rates have also been observed to fall sharply, with more bills being passed
than previously. This is due to fewer coding errors or other factors, which is
a natural advantage when you have dedicated and experienced personnel on your
team.
About
24/7 Medical Billing Services:
We
are a medical billing company that offers ‘24/7
Medical Billing Services’ and support physicians, hospitals, medical
institutions and group practices with our end to end medical billing solutions.
We help you earn more revenue with our quick and affordable services. Our
customized Revenue Cycle Management (RCM) solutions allow physicians to attract
additional revenue and reduce administrative burden or losses.
Contact:
24/7
Medical Billing Services
Tel:
+1 888-502-0537
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