Orthopedic Practices
Efficient Medical Billing for Orthopedic Practices:
Maximizing Returns, Ensuring Compliance
Orthopedic Practice Billing
Orthopedic practices specialize in diagnosing, treating, and managing conditions related to the musculoskeletal system, which includes bones, joints, muscles, ligaments, tendons, and nerves. Orthopedic billing faces several challenges, including the complexity of procedures requiring multiple codes, the proper use of modifiers, and staying updated with frequent changes in CPT codes.
Additionally, ensuring accurate and thorough documentation is crucial to avoid claim denials, and navigating payer-specific guidelines can be time-consuming. Managing a high volume of claims efficiently is also a significant challenge for orthopedic practices. By outsourcing medical billing to a specialized RCM company like us, you can enhance billing accuracy and efficiency, leading to faster reimbursements and improved cash flow. Additionally, it ensures compliance with the latest regulations, reducing the risk of legal issues and allowing the practice to focus more on patient care.
Unbeatable Service, Quality & Price
ACCURACY
0
%
TURNAROUND TIME
<
0
Hours
COLLECTION
0
%
PRICE
Starting from $
1100
/Month
CHALLENGES
Challenges in Orthopedic Practice Billing
Complexity of Procedures and Multiple Codes: Orthopedic treatments often involve a combination of surgeries, therapies, and follow-up care, requiring the use of multiple billing codes. This complexity increases the risk of coding errors, which can lead to underpayment or claim denials.
Proper Use of Modifiers: Modifiers are essential in orthopedic billing to indicate that a procedure or service has been altered in some way without changing its basic nature. Incorrect use or omission of modifiers can result in claim denials or incorrect reimbursements.
Managing Bundled and Global Billing Periods: Orthopedic surgeries often include global periods, where post-operative visits and follow-ups are bundled into a single payment. Billing outside these timeframes can result in denied or delayed claims.
OUR PROCESS
Our Orthopedic Practice Billing Process Workflow
At RCM Workshop, orthopedic practice billing process involves many critical steps to ensure accurate and timely reimbursement. We start with patient registration and insurance verification to confirm coverage and benefits. Then we obtain prior authorization for specific procedures and carry out accurate medical coding using CPT, ICD-10, and HCPCS codes. We enter these coded services into the billing system and electronically submit claims to insurance companies. Besides, we perform payment posting, denial management, and patient billing to reconcile payments, address claim denials, and manage patient balances.
We also follow up on accounts receivable to monitor outstanding claims and ensure timely collections. We identify trends and areas for improvement by generating reports for financial analysis and ensure compliance with regulations. Implementing a systematic and efficient billing workflow can significantly enhance the financial health of your orthopedic practice by reducing errors, improving cash flow, and ensuring accurate reimbursement.
Scheduling & Registration
Carry out well-coordinated appointment scheduling, update insurance details, and handle inbound and outbound calls from/to patients.
Eligibility & Benefits Verification
Confirm primary and secondary insurance and benefits coverage of patients and verify their coverage, co-pays, co-insurance, and deductibles.
Prior Authorization
Initiate request for prior authorization with the payer, follow up to check its status till closure and finally update the system with Auth approval reference number.
Medical Coding
Check the accuracy of codes and modifiers according to specialty and assign corresponding and appropriate charges to the codes.
Charge Posting
Enter the charges for the services provided into the billing system including the cost of the medication and the administration fee.
Claims Edits & Submission
Audit the claims thoroughly to check for accuracy and edit if necessary and submit claims – both EDI and paper format.
Payment Posting
Carry out both auto as well as manual posting for payments received and conduct reconciliation against claims.
Denial Management
Analyze and categorize denial claim according to denial codes, $ amount and payers, and resubmit claims after correction.
AR Management
Follow-up with payers to gather status for unpaid claims, and their resolution.
Patient Collection
Sending patient statements and follow-up with patients for final and outstanding payment.
You can confidently rely on us to manage your entire billing process, or you have the flexibility to select specific DME billing services that suit your needs, ensuring a seamless operation without any interruptions.
BENEFITS
Outcomes guaranteed
We employ top industry practices and a data-driven approach to optimize revenue cycle processes while maintaining the highest quality standards. Our aim is not just to manage your revenue but to enhance it. Our orthopedic billing services are tailored to fit your workflow, ensuring significantly improved financial outcomes.
WHY US?
Why partner with us
Partnering with us can significantly benefit your orthopedic practice by enhancing efficiency and accuracy in billing processes. We employ experts who specialize in orthopedic coding and billing, reducing errors and claim denials, leading to faster reimbursements and improved cash flow. Additionally, we stay updated with the latest regulations, ensuring compliance and minimizing legal risks. By outsourcing billing tasks, your practice can focus more on patient care, ultimately improving overall efficiency and financial outcomes.