Coverage & Benefits Considerations

Just because someone has insurance coverage for other healthcare, there is no guarantee that coverage is available for Durable Medical Equipment (DME) like custom orthotics. And then, even if there is orthotic coverage, there may be restrictive limitations on the conditions for which orthotics may be prescribed. Sometimes, the payer requires DME to be dispensed by a licensed DME supplier to be a covered benefit. This overview tutorial calls attention to the most important considerations when reviewing coverage for your patients for the potential coverage of custom orthotics through their health plan. It also includes a demonstration on how to find the Medical Review Policy for orthotics, if one exists. Download and refer to the sample Reference Document which is an example of the details in some payers’ Medical Review Policy for orthotics.

Download Reference Document

Sample Medical Review Policy (MRP) for Orthotics


Policy Disagreement

What to Do? Have you ever opened a Payer Newsletter and seen something you completely disagree with regarding reimbursement or coverage? What is your first reaction? Do you jump on social media, send the link to colleagues, and threaten to go ‘all cash?’ Is there anything else you can do? At KMC University we have...
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working 1-on-1 with our specialists for analysis and training. Please reach out to the HelpDesk to learn more about accessing these materials. Click here to learn more.

Patient Responsibility – Identify & Assign

Streamline Your Collection Process Charge entry is only as good as your practice management set up. When entering procedures and supplies, it is necessary to identify items that would be considered patient responsibility. This is the only way you can streamline your collection process and increase revenue in your clinic. Insurance Charges Assigning patient responsibility...
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working 1-on-1 with our specialists for analysis and training. Please reach out to the HelpDesk to learn more about accessing these materials. Click here to learn more.

The Window to Coverage and Benefits

Coverage and Benefits For a clinic to run efficiently, the staff must be familiar with the terms Summary Plan Documents (SPD); Summary of Benefits and Coverage (SBC); Payer Medical Review Policy (MRP); Payer Reimbursement Policy; Policy Guidelines; Payer Clinical Guidelines, and the Provider Manual. The mini-class titled MRP-What Does It Mean to Me? provides a...
OOPS, this page contains content reserved for KMC University members. We’d love to welcome you to the KMC University family because there is an amazing amount of helpful content in the trainings and resources of the KMC University Library. Click here to learn more.

MRP – What Does it Mean?

If you bill insurance, the Medical Review Policy (MRP)  is one of the most important documents for successful billing and reimbursement. In this quick tutorial you will have the opportunity to view the process of viewing and downloading  these documents online.
OOPS, this page contains content reserved for KMC University members. We’d love to welcome you to the KMC University family because there is an amazing amount of helpful content in the trainings and resources of the KMC University Library. Click here to learn more.

Commercial Health Insurance Verification Mastery

This tutorial provides tips and tricks for the clinic to master the verification process. The staff member will learn how to use the verification template for gathering information that can assist with reimbursement. We even provide a peek at the many resources a clinic can find online via payer portals that help the clinic avoid...
OOPS, this page contains content reserved for KMC University members. We’d love to welcome you to the KMC University family because there is an amazing amount of helpful content in the trainings and resources of the KMC University Library. Click here to learn more.