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Sample Policy for: Prescribing and Billing for Orthotics

This office recommends, prescribes, and dispenses functional orthotics to patients. We recognize that orthotics may be considered medically necessary to certain third-party payers according to their medical review policy and depending upon the patient’s working diagnosis.

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This office participates with various insurance carriers. We recognize that it is our responsibility to properly verify our patients’ benefits, along with the coverage policy for orthotics supplied by the carrier. We do our due diligence to confirm the covered conditions and diagnoses that are considered medically necessary by the carriers. We only bill directly for orthotics when all of the coverage conditions are met.

This office does not participate with any insurance carriers, but we will bill on behalf of patients at their request. We recognize that it is our responsibility to properly verify our patients’ benefits, along with the coverage policy for orthotics supplied by the carrier. We do our due diligence to confirm the covered conditions and diagnoses that are considered medically necessary by the carriers before billing. We only bill directly for orthotics when all of the coverage conditions are met, even though we do not accept assignment.

If the carrier does not cover orthotics for a patient’s condition, we confirm that it’s appropriate to pass the cost along to the patient prior to ordering the orthotics. If the patient directs this office to order the orthotics and s/he assumes financial responsibility when the insurance won’t pay, we always obtain advance notice documentation signed by the patient to ensure the circumstances are clear.

We stay current on proper coding for the type and style of orthotics dispensed. We carefully explain the financial situation to all patients prior to ordering and dispensing orthotics.