Technical advancements in orthoses create reimbursement challenges

ORLANDO, Fla. – Although advancements in orthoses provide increased function and mobility for many patients, they also present reimbursement challenges for practitioners. Kimberly Hanson, the director of reimbursement for Ottobock North America, discussed how to manage these issues at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium, here.

When dealing with reimbursement, Hanson recommended first reviewing the medical coverage policy and any specific language related to custom orthosis coverage or exclusions.

“You might also want to review your payment methodology for that contract just to protect yourself on the back end after you submit your authorization and claim,” Hanson said.

She also emphasized the importance of written documentation when trying to justify a new device to an insurance provider.

“When you are evaluating the patient, make sure you document everything,” Hanson said. “I know that is easier said than done, but if you do your work on the front end during your assessment, you will you have the justification you need if you do need to appeal.”

Video documentation of a patient’s ambulation assessment can also be helpful when submitting a claim, as well as listing limitations presented by the patient’s current device, experiences with past devices and functional goals for the new device and including any multidisciplinary references that are available.

“And after you submit your prior authorization, be prepared to appeal the denial,” Hanson said. “Often, payers don’t understand the technology, so make sure you that have your complete package and are prepared.”

Hanson also suggested including patients in the reimbursement process, because they are often willing to advocate for themselves directly to the payer.

For more information:

Hanson K. Advanced Orthosis Reimbursement. Presented at: American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium. Feb. 20-23, 2013. Orlando, Fla.

Leave a Reply

Your email address will not be published.