Orthotics Billing: How to Improve First-Pass Acceptance Rates

If you run a practice that provides orthotic devices, you know how frustrating insurance claim rejections can be. A claim is denied, which means it delays your payments. It not only slows down your operations but also puts pressure on your team and affects your cash flow. You do the work and give patients the care they need but getting paid feels like a constant battle. The truth in orthotics billing is that all these can be resolved if your claim management is in right track.   Claims denials can be easily avoided if careful attention is given. A lot of them happen because of small errors or missed steps. The best way to fix this is by improving your first-pass acceptance rate. This means making sure your claims get accepted by insurance payers the first time you send them in. When your first-pass rate is high, that means you have an efficient cash flow. Your payments come in faster, and your revenue stays steady. It also saves your team from wasting time on rework and follow-ups. 

Where things go wrong: common pain points in orthotics billing 

There are three common problems that hurt your first-pass acceptance rate. The first one is incomplete eligibility checks. If you are busy, your front desk staff might rush and skip full insurance verification. When that happens, you may submit claims for orthotics that aren’t covered, need prior authorization, or have specific limits under the patient’s plan. These kinds of denials are easy to avoid, but they still cause a lot of claim rejections. 

The second problem is using the wrong codes. Orthotics billing uses detailed HCPCS L-codes, and even a small mistake can lead to a denial. You might also forget to add a modifier or miss certain documents the payer needs. If you don’t code correctly, it not only delays payment, but it can also cause compliance issues if it keeps happening. The third issue is what billing teams call a “dirty claim.” This is a claim that may be correct in terms of the service you gave but has small errors. Maybe the patient’s name is misspelled. Maybe the NPI is missing, or the formatting is wrong. These small issues still lead to instant rejection, especially now that payer systems are automated and very strict. 

Strengthening eligibility checks  

One of the best ways you can improve your first-pass acceptance rate is by fixing your eligibility verification process. Not always it is enough to just check if the patient has an active insurance plan. You need to check all the details minutely. 

Every insurance plan is different when it comes to orthotics. Some plans might pay for off-the-shelf braces, but not for custom ones. Others might ask for prior authorization or special documents before they pay. 

To avoid problems later, you should do a full eligibility check before every patient visit. This means looking at plan rules, what documents are needed, and whether you need to get approval ahead of time. Make sure you write everything down and check the details using the payer’s website or your clearinghouse. 

If your front desk or billing staff is too busy, you might want to get help from a company that provides orthotics billing services. These companies often have tools that check eligibility automatically and follow payer-specific rules. This saves you time and helps avoid mistakes, one of the top reasons claims get denied. 

Getting the coding right not once, but every time 

When you bill for orthotics, your coding needs to be exact. Many people get confused between custom-fabricated, custom-fitted, and off-the-shelf devices. Each type uses different HCPCS L-codes, different pricing, and different paperwork. You might have used the wrong code or forgot a modifier, your claim can get denied, even if everything else is correct. 

You need to train your team often on the latest coding rules. Both CMS and private payers update their guidelines from time to time. Your staff should know these updates and apply them correctly when filling out forms and sending claims. 

Coding might feel too complex or time-consuming. In that case you can work with an orthotics billing company that specializes in this area. Their team understands the small details that make a big difference. Instead of using general advice, you will get support that’s specific to orthotics billing. This can help you avoid many denials caused by coding mistakes. 

Learning from your claim denials in orthotics billing 

Improving your first-pass acceptance rate isn’t just about avoiding new mistakes. It is also about learning from the ones you have already made. Many practices forget to track their claim denials. But these denial records are full of helpful information.  

You should create a simple report that groups denials by reason. For example: eligibility issues, wrong codes, formatting errors, or missing paperwork. Look at this report every month and try to spot patterns. Maybe one payer always rejects your custom AFO codes. Or maybe one team member keeps using the wrong place of service code.  

Some orthotics billing services offer denial tracking tools that make this easy. Their dashboards help you sort and understand your denial data in just a few clicks. But even if you don’t have fancy software, you can start with a basic spreadsheet. That’s much better than guessing. 

Few other tips for orthotics providers for better ROI 

Your first-pass acceptance rate is not just a nice number to track; it is a big deal for your revenue. When a claim gets rejected and you have to fix and resend it, your team spends extra time and energy. Sometimes, rejected claims get missed completely, and that means lost income for your practice. 

A good first-pass rate is 90% or higher. The best practices aim for 95% or more. If you can reach that level, it means your claims are accurate, properly coded, and meet all the payer’s rules right from the start. But getting there takes more than just experience in billing. You need to improve your process at every step, from checking patient info at the front desk to submitting the final claim. 

If you are tired of chasing down denials and waiting too long to get paid, now might be the right time to outsource orthotics billing to a team that knows your specialty. This can take the pressure off your staff and keep your payments coming in on time. Your team and your bank account will feel the difference.