Accounts receivable management for orthotics and prosthetics remains a challenge for most practices. This persistence may be due to high reimbursed device charges, document requirements, prior authorizations, and changing payer guidelines for these services.
Without organizational AR management, there may be rapid aging of the receivable amount due to reduced cash flow. In O&P, effective AR management is accomplished by a good blend of front-end controls, accurate record-keeping, follow-ups, and data analysis. In particular, some effective tips to help O&P practices in this matter can be considered below.
Understand the Unique AR Challenges in O&P
Prior to performance improvement activity, an understanding of typical difficulties in accounts receivable within O&P is necessary. These often include:
- Inadequate prior authorizations prior to treatment
- Lack of documentation to verify medical necessity
- Errors in custom device codes
- Delays in delivery confirmations
- Payer audits and post-payment reviews
- O&P reimbursement is closely related to compliance, and small gaps can also cause payment delays.
Enhance Insurance Verification and Authorization Processing
Many accounts receivable issues appear at the point of intake. Ineligibility or authorization issues can be seen weeks later when claims go unpaid. To decrease downstream AR:
- Verify insurance coverage prior to assessment and fitting
- Confirm the limits of benefits, terms of coverage, and patient responsibility
- Obtain and document the authorizations on each device
- Reconfirm approvals before delivery
- Good front-end systems decrease denials and increase first-pass acceptances.
Enhance Documentation Consistency
Document quality affects the orthotics and prosthetics AR. Payers require clear clinical justification for each device submitted on a claim. Best practices include:
- Strong diagnosis-to-device alignment
- Documentation of functional deficits and expected outcomes
- Proof of delivery with patient signatures
- Correct serial numbers and product names
- Standardized templates assist in covering all expectations from the payers.
Make Submissions Promptly and Accurately
A delayed or incorrect submittal of claims can contribute to AR risk of aging or denial. O&P practices should strive for submittals of clean claims immediately following delivery. The important steps involved are:
- Checking documents before billing
- Verifying correct HCPCS codes and modifiers
- Verifying units and dates of service
- Monitoring rejections in clearinghouses on a
- When this occurs, there will be faster payments and less rework.
Track Denial and Appeals
Denials are a big source of backlog in accounts receivable for orthotics and prosthetics. Without a proper procedure for the denial, the case can linger unresolved for months. Effective denial management entails:
- Classifying denials by reason
- Uncovering patterns in payer issues
- Appropriate preparation and submission of appeals
- Monitoring outcomes and timelines of appeals
When Outsourcing AR Makes Sense
As the rules from the payer become more complicated, many practices now outsource their O&P accounts receivable services to expert services like RCM Workshop. Using outsourced services to manage AR is very beneficial to an organization in that it can increase efficiencies without increasing the number of internal staff employed. Benefits of outsourcing accounts receivable include:
- Creation of teams for follow-up and evaluation of AR
- More timely processing of outstanding unpaid claims
- Understanding of payers’ O&P-specific policies
- Improved cash flow and regularity
Outsourcing accounts receivable management for O&P to RCM Workshop gives your internal staff the opportunity to focus on providing patient services while providing a stable revenue source for the practice. Efficient management of accounts receivable is critical to orthotics and prosthetics practices being viable for the long term.
