Touch Bionics Reimbursement Support
Often times, reimbursement is where things get hung up for many of our customer’s clients who are seeking a myoelectric upper limb prosthetic device, like the i-limb® or i-digits™. Some of the scenarios we have encountered are:
- Insurance won’t budge on covering myoelectric devices with multi-articulating digits
- Insurance won’t cover all the technology (unlisted codes representing enhanced features)
- A submission package missing some finer details was submitted to insurance resulting in a denial
The scenarios are nearly endless but with our dedicated three person team we are living and breathing all of these situations day in and day out. Before we get into all the services we offer for FREE here are some things to always keep in mind when submitting a reimbursement package to insurance:
- Obtain clinical approval: Set appropriate expectations
- Select the appropriate device: How much technology can we expect the payer to approve?
- Nail down medical necessity: LMNs specifically identify the device being sought, LMNs come from the prescribing MD and are supported by OT and prosthetist notes
Additionally, for Medicare submissions, the primary focus is on Physician notes/LMN, but for commercials/WC you will need accordant notes/LMNs from the doc, the prosthetist and an involved OT
- Obtain prior authorization whenever possible: Touch Bionics will support you through this process with templates, submission package reviews, and relevant supporting documents
Clinical approval: What is involved?
- Obtain photos for our clinical team to review for optimum device recommendation
- Confirm myosites are adequate to operate the chosen device
- Review difficult presentations: i-digits™ vs i-limb®, Size, weight, length, Other components needed
- Decision to proceed / risk management
- Set appropriate expectations
Make sure that you know exactly which device you are looking to get approved
- i-limb® or i-digits™
- How much technology can we expect the payer to approve
- Set appropriate expectations
The number one thing to always keep in mind with your client is the setting of clear expectations throughout the entire process.
Unfortunately, often times the next step in this lengthy process may end up being a denial from the insurance provider which means you need to buckle down. Keep in mind, and remind your client that denials happen quite often for those seeking reimbursement for a myoelectric upper limb prosthetic device and you should NOT give up on the case.
Some of the most common denials for upper limb myoelectric prosthetic devices include the following:
- Body powered is sufficient
- 99 codes are not reimbursable
- Least costly device only
- Experimental / Investigational
Touch Bionics has a library of documents to use when fighting denials so reach out to us for help at any time!
Our reimbursement support services cover the following areas and more:
- Initial Billing and Coding guidance for all products in our portfolio
- Claim support to justify medical necessity for i-limb technology
- All patient information shared with our reimbursement staff is confidential and in compliance with HIPAA regulations
- Expert review of key documentation compiled from Reimbursement Quick Start Checklist and feedback within 24 hrs – Purchase order discounts available for each insurance package reviewed by our expert reimbursement staff prior to insurance submission
- Reimbursement assistance to turn around denials, with denial review & appeal preparation, if needed
- Full range of additional supporting tools and sample templates
- Our Total Billing Service includes all of the above as well as compiling & creating the submission package, sending in the claim, and ensuring reasonable payment is received from the payer(s)
To utilize Touch Bionics' reimbursement support services, contact one of our reimbursement specialists at 1-855-MY iLIMB, ext. 3 or email us at email@example.com