You already know that orthotics billing can be overwhelming. You must ensure that you get paid optimally for each service provided. Things would have been easier if it were a cash-only practice, but since you receive most payments from your patients’ insurance companies, you need to submit clean claims for maximized and timely reimbursements. It is crucial for you to have a proper understanding of specific billing guidelines for your orthotics practice. You need to know what orthotics providers deal with when they handle insurance coverage in their billing process.
Insurance coverage in the billing process of your custom foot orthotics process:
You should always check with the patient’s insurance to see if custom foot orthotics are covered, as coverage varies by company and policy. Many times, you will find out they are not covered, and the patient will have to pay out of pocket after you have gone through the verification process. You should ask out-of-network patients for cash payment and give them a letter explaining medical necessity along with an HCFA form to file a claim. You can also suggest they use a Flexible Spending Account. Do not forget to inform them about fittings, follow-ups, and adjustments for their orthotics.
Now you need to understand the accurate CPT, HCPCS and modifiers used in your billing process:
HCPCS CODE L3000: You should use this code to document the foot, removable insert, molded-to-patient model, and 'UCB' type.
You should always check your patient’s health plan guidelines to see if these codes are covered. Insurance policies vary, and what is covered for one patient may not be covered for another. Verifying benefits in advance helps you avoid unexpected denials and ensures your patients know their fiscal responsibility upfront.
Also, one thing you should always keep in mind is that Medicare doesn’t cover custom foot orthotics.
Now, you need to know the critical challenges associated with orthotics billing services so that you will be able to navigate them efficiently.
Vital challenges in your billing process:
You need to create a claim that is accurate, complete, and will not get rejected. That means paying close attention to every detail and knowing all the billing rules. The hardest part is getting the coding right—like understanding the difference between CPT codes and L codes. Plus, one insurance company might cover something that another will not. Knowing these details helps you avoid denials and get paid faster!
You need to be careful with the details. List right-foot and left-foot orthotics separately with the correct code and “-RT” or “-LT” modifier. If unsure, check with your provider to ensure accuracy. Avoid using general or unlisted codes (like CPT 29799) unless there is no better option—using the exact code helps prevent claim issues!
You can avoid errors in your orthotics billing and focus fully on patient care. How? Just outsource your orthotics billing to a professional revenue cycle management company. This helps you cut costs and boost your practice revenue. So, do not waste your valuable time and outsource your billing process now.