Wiki Waiver Form for Orthotics

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TenaWright

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I code for DPM services in an RHC outpatient setting. We provide custom orthotics to many of our patients. My question is regarding the necessity of having a Waiver of Liability on file when ordering the orthotics for subsequent pairs - utilizing the same mold obtained at a previous visit. Is it necessary to have a Waiver form on file for EACH pair of orthotics dispensed? Currently I am getting blowback from a provider who wants to bill L3030 for the subsequent pairs without the Waiver being signed for that additional pair. I believe it is improper to bill insurances without proof of what was dispensed and for what purpose. Any advice you can provide is welcome.
 
A couple things before I can help...what is the waiver of liability in your clinic? What type of orthotic is being provided, specific type?
 
The waiver form just states that the patient understands that their insurance may not pay for the orthotics, that the orthotics are considered DME, and that they are willing to be balance-billed if necessary. It includes several codes for custom orthotics with current prices listed. When providing this service to our patients, we take custom molds of their feet in the office and order the orthotics from Mercury Labs. They include full-length, 3/4-length, and Berkley w/ deep heel mold. We include L3010, L3020, L3030 on this form as well as CPT 97760 and HCPCS L4210 in the event we need to return previous orthotics to the lab for adjustments. I currently have two patients with this situation. One has commercial insurance and the other has Medicaid - neither are on Medicare.

This is the text of the waiver form:
"The Podiatry Department may decide to fit you for custom orthotics. Custom orthotics may not be a covered benefit of your insurance plan. We recommend that you contact your insurance company with the information provided below to determine if the orthotics will be paid for by your insurance."

"Orthotics come in a pair and are NON-REFUNDABLE durable medial devices."

We also have an area at the bottom of the form where we list diagnoses for patient convenience when they are calling the insurance to query coverage.
 
Okay, I figured that is what you were referring to. If you are billing insurance for that second pair, then, yes absolutely get the waiver. The orthotics should not be billed to the insurance until they are dispensed. It's a good policy to collect a deposit upfront on all pairs (except medicaid) that way if the patient doesn't pay at least the lab fees are covered.
I asked about the code because I have found that many DPMs bill the wrong code for the type of orthotics they are dispensing leaving money on the table. Most custom orthotics are L3000
The L3030 is molded directly to the patient's foot with an external heat source. L3020 has very little heel cup and is intended to control the forefoot through the longitudinal arch and metatarsal support. The L3000, on the other hand, is a UCB type, functional, reducing pathological forces, molded heel cup 10mm min and provides both medial and lateral directive forces to control the forefoot and hind foot.
 
podcoder70 said:
Okay, I figured that is what you were referring to. If you are billing insurance for that second pair, then, yes absolutely get the waiver. The orthotics should not be billed to the insurance until they are dispensed. It's a good policy to collect a deposit upfront on all pairs (except medicaid) that way if the patient doesn't pay at least the lab fees are covered.
I asked about the code because I have found that many DPMs bill the wrong code for the type of orthotics they are dispensing leaving money on the table. Most custom orthotics are L3000
The L3030 is molded directly to the patient's foot with an external heat source. L3020 has very little heel cup and is intended to control the forefoot through the longitudinal arch and metatarsal support. The L3000, on the other hand, is a UCB type, functional, reducing pathological forces, molded heel cup 10mm min and provides both medial and lateral directive forces to control the forefoot and hind foot.
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Thank you very much for your guidance and response!
 
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