Orthotics and Prosthetics may be subject to a co-pay or coinsurance. Payer requisites vary and authorization is required. It is considered to be a key component of the benefits provision of the member. The general billing requirements with Orthotics and Prosthetics devices will be:

? Prior to the delivery date, a prescription is required from the ordering physician

? Based on time period, limitations has to be considered within which an item is supplied earlier, can be covered. An example of this will be a pair of orthotic friendly shoes are covered in a calendar year by the Medicare!

? Use of the appropriate modifiers to be billed e.g. KX, LT / RT, NU etc.

? Coverage of devices also subject to qualifying diagnosis, E.g. Orthotic shoes not covered unless diagnosis states diabetic

? Repair, replacement and supplies may be eligible for separate reimbursement.

? Letter of medical necessity and additional documentation may be required for some devices, e.g. PPR form for prosthetic devices, Diabetic Verification Form for diabetic patients etc. It is subject to medical review by the payer

Challenges and the approaches in Orthotics and Prosthetics Billing

Sunknowledge delivers end to end revenue cycle management assistance in Orthotics and Prosthetics billing. We approach the challenges in each task with effective error management; superior tracking mechanism and extensive audits, helping you increase your claims and billing efficiency while reducing the chances of denials.

Our proven process performance, clear communication and dedicated account management support is the reason why we are working with over 100 clients in the Orthotics and Prosthetics space with excellent references.

With a special focus on denial management, enhancing claims processing to over 98% in a TAT of 5 to 10 days, we are your one stop destination for cutting edge orthotics and prosthetics billing. We help in reducing your overhead costs and our versatility across all practice management/billing platforms guarantees best collections.

Almost 30% O&P Rx is incomplete when received first, our excellence in quick handling of Rx claims, demonstrated experience in handling Medicare, Medicaid and other commercial plans, makes us a champion healthcare revenue cycle management company!

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