The complexities of medical billing don’t stop at services. Prostheses, orthotics, and durable medical equipment (DME) all have to be coded and submitted in a claim before insurers or government payers will cover any of the costs. Every payer has different prostheses billing guidelines & rules about what is covered and under what circumstances, making it very difficult for medical office staff to keep up with all the details.
Outsourcing medical billing and coding to a professional revenue cycle management (RCM) company like Medcare MSO has proven to be a stress-free solution that increases our clients’ income. Our billers are certified and experienced in dealing with prostheses, and all our staff are also trained in HIPPA compliance, so you don’t have to worry about patient data being secure.
Even a practice that performs routine exams and treatments benefits from having their billing managed by dedicated professionals, but for something as involved as prostheses, which may even be customized for each patient, medical billing requires experience and expertise to get it right. And because each item can be a high-dollar claim, it is important that coding be right, or significant amounts of revenue can be lost. These are a few additional aspects of prosthetics that make coding and billing complex:
The coding for fitting and adjusting prostheses includes the office visit, so billers must be aware that they may not also use the code for a visit in the claim.
There is some overlap between the codes for providing and adjusting prostheses and time spent by a skilled clinician training the user. Anyone billing for prosthetics must know how to properly identify and code for each instance and know how to use modifiers to indicate reduced services so that there is no duplicate payment. Failure to do so can result in over-coding, and ultimately in fraud charges against the physician.
Not all prosthetic devices have been submitted for product review, so they do not have their own codes. Medical coders and billers must know how to find the correct codes to use in these cases. Tracking down information can be time consuming, leading labor costs to exceed the value of the claim.
Evolvex Solutions is a full-service prostheses billing RCM provider with a large staff of dedicated, experienced billers. Our innovative approach to medical billing includes our own proprietary software that ensures all the latest codes are in the system and our billers know what to look for and how to avoid rejected and denied claims.
When claims are rejected or denied, our billers swiftly determine what went wrong and get the complete information and correct coding resubmitted. This can take hours of office staff time when it is handled by less experienced coders and billers, resulting in even more lost revenue due to labor costs. Outsourcing to a professional prostheses medical billing company gets you the maximum reimbursement and least unpaid claims.
In addition to medical billing, we also provide payer credentialing management, compliance reviews, annual payer adjustments and payback, bill collection, and much more. Our prostheses medical billing services are completely customizable so we can meet the needs of any size client. Get a free demo today to see how we can help streamline your RCM and increase your income.
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