How Does An Increase In Accounts Receivable Affect Cash Flow Prosthetic Billing Outsourcing: Why It’s Important

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Prosthetic Billing Outsourcing: Why It’s Important

Outsourcing prosthetics billing is a fairly common practice among healthcare providers, orthopedics, and DME vendors. The main reason is the inability of the internal staff to cope with the typical billing of prosthetic and orthotic work. Often subject to payment and/or coinsurance, orthotics and prosthetics coverage has different requirements for different devices and varies by payer. This should be within the member benefits provisions. A prosthetic biller has a lot of work to do. That includes:

• Get a prescription from the doctor who ordered the medicine before the delivery date.

• Consider coverage item limits based on a fixed time period. Example: Medicare covers a pair of orthotic shoes for a calendar year.

• List the appropriate modifiers.

• Check the letter of medical necessity and additional documentation required for some devices. Example: PPR form for prosthetic restorations.

• Check coverage of devices subject to a qualifying diagnosis.

• Consider repair or replacement and supply for separate reimbursement as applicable.

Most providers, orthopedic and DME companies see their billing staff spend a lot of time suppressing these operations which prove to be quite time-consuming and burdensome as they are already overwhelmed with various responsibilities. Add to that the in-depth knowledge of Medicare, Medicaid and commercial plan reimbursement guidelines, their caveats, etc. required to perform these tasks expertly. Operational inefficiencies in these areas directly affect cash flow as receivables denials increase and receivables collection takes a hit. This is why you should consider outsourcing the billing of dentures.

Prosthetic billing outsourcing: how it helps

A trusted medical billing service that offers prosthetic (and orthotic) billing solutions will provide you with a host of features including:

Eligibility check

• Check the active policy for the date of service

• Check the entry of Co-pay / Co-insurance / OOP, Rx & Dx

• Check the status of the service provider

• Check the authorization request

• Obtain authorization

Authorization check

• Follow up to resolution and closure

• Complete the authorization process efficiently

• Check periodically to maintain the validity of the authorization

Medical coding

• Coding based on place of service: coding of inpatients and outpatients

• Coding based on provider specialty: E/M, cardiology, orthopedics, physical medicine, etc.

• Assign the appropriate ICD-10 codes for the diagnosis

• Assign modifiers as needed

• Code review and quality assurance

• Communication with the doctor’s office for additional medical documentation and necessary clarifications

A/R analysis

Analyze A/R

Payer tracking

Claims closing

Rejection management

• Correction of requests

• Resending

• Patient responsibility

However, you need to be very careful and look for a billing partner that can handle your prosthetic billing needs within your budget and provide you with a revenue cycle management/practice management solution from start to finish.

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