Orthotics Billing: When to Bundle and When to Bill Separately

Orthotics billing may seem simple, but it's pretty complex. If you provide orthotic devices, you're familiar with the complexity of billing. One big mistake is not knowing when to use bundled billing and when to send separate claims. Many practices, especially with inexperienced in-house teams, get this wrong. Each small mistake causes claim denials, payment delays, and revenue loss, thus requiring you to understand when you should go for bundled billing and create separate claims. 

Know what bundled orthotics billing is: 

Bundled billing means you add related services or items under one claim. For example, if a patient gets an evaluation, a cast, and custom foot orthotics on the same visit, some of these can be billed together. Sometimes, payers want you to bundle services. It reduces paperwork and makes things much easier. But here's the tricky part: you must follow the rules. If you bundle the wrong way, your claim gets denied.  Now you should know when to go for creating separate claims. 

Separate Claims: When to Bill Orthotics on Their Own 

In some cases, you must send separate claims for orthotic devices and other services. This happens when the payer says orthotics must be billed separately, the services were done on different dates, different providers were involved, or modifiers are needed to show medical need. Separate claims make things clear for the payer. They can see what was done and why. But your team must use the right codes, modifiers, and proper paperwork. 

Let's keep it simple. Here are situations where you should opt for bundled billing and separate billing: 

Bundled or separate orthotics billing: Know about the right situation 

You can bundle orthotics billing when everything happens on the same day. This includes the evaluation, casting, and fitting. Some payers clearly say these services should be billed together.  For example, if a patient comes in for plantar fasciitis treatment, gets an exam, casting, and custom foot orthotics on the same visit, the payer may ask you to bundle those into one claim. But this depends on the payer's rules. You should send separate claims if the services happen on different dates, if more than one payer is involved, if the orthotics are given after surgery as follow-up, if each service needs separate approval or if the custom orthotics are delivered much later. Separate claims take more work but help avoid denials when bundling is not allowed. 

Many small clinics or practices rely on their in-house team to handle orthotics billing. But here's the truth - unless your staff specializes in billing for orthotic devices, mistakes happen, and the following are the common errors: 

Many in-house teams make mistakes with orthotics billing. They bundle services that should be billed separately. They forget to add modifiers when sending separate claims. Sometimes, they use old HCPCS codes for orthotics. They also miss out on payer-specific bundling rules and state rules. These may look like small mistakes, but they cause big problems. Claims get denied, payments get delayed, and you lose money. If these errors keep happening, you may even face audits or compliance issues. 

Let's face it. Orthotics billing rules change. Payer policies vary. Coding requirements update every year. Expecting your in-house staff to stay updated on all these details is tough, especially if they're already juggling other tasks. This is where a dedicated orthotics billing company can help. 

Know how a professional orthotics billing company helps: 

A professional billing company knows how to handle orthotics billing the right way. Their team follows payer-specific bundling rules and uses the latest HCPCS codes. They also understand state-wise billing rules. They use clean claim strategies to avoid denials and apply the correct modifiers when needed. They stay updated on documentation and compliance rules. The best part is that they offer full boutique RCM services. This means they take care of prior authorization, claim submission, virtual assistance, AR and denial management, charge posting, and more. They also provide billing support across 35+ specialties like cardiology, radiology, infusion, DME, dental, and many others. This helps reduce errors, speed up payments, and improve your revenue. 

So, enjoy an excellent cash flow and revenue foundation with a perfect orthotics billing company.