An orthopedic group’s financial strength is directly related to the efficient submission of its claims along with receiving timely and accurate reimbursements. While it may seem like a simple task, there are a lot of complexities associated with the orthopedic medical billing process. The complicated nature of this task can be primarily attributed to the wide scope of surgical and non-surgical services and procedures that orthopedic providers perform; payer specific rules and guidelines; and complex billing codes. Orthopedic billing specialists thus require a deep domain understanding of the providers’ services to ensure claims are processed correctly. Unfortunately, this is not always the case. Approximately 35% of all orthopedic surgery claims are processed incorrectly by commercial carriers. Additionally, over 25% of medical claims are rejected, out of which 15% are never resubmitted. As a result of preventable billing errors, orthopedic surgeons are leaving billions of dollars of revenue on the table annually.

Given the high-cost value of these services, high denial rates can lead to significant revenue losses, which in turn would have a detrimental effect on patient care. It is therefore critical to have experienced resources to accurately code and bill charts to maximize revenue efficiency. We are one such orthopedic billing company that is committed to providing you with effective and efficient orthopedic medical billing services to improve your clean claim submission rate, increase cash flow and reduce denials.

The 3Gen Advantage

Partnering with 3Gen means having the opportunity to optimize your orthopedic medical billing processes. We act as an extension of your team and provide you with customizable and scalable solutions to ensure you experience greater efficiency and enable your business to thrive. Your success is our success. Still not convinced? Here are some additional reasons to highlight the 3Gen orthopedic medical billing services difference.

Extensive Knowledge On The Orthopedic Medical Billing Nuances

The revenue cycle regulatory environment is becoming more complex each day. Navigating through this is a challenge. It is important, now more than ever, to adapt processes to the changing regulations and guidelines to ensure compliance. We help clients transform their orthopedic billing by leveraging our well-defined and updated processes to avoid any severe non-compliance penalties.

Excellent Orthopedic Billing & Coding

Our highly trained and experienced team of professionals are well-versed in the intricacies of orthopedic medical billing services. Our AAPC certified coders are proficient in assigning ICD, CPT, HCPCS codes and modifiers to multiple procedures, while our billing professionals have an outstanding performance history of processing claims with commercial and government payers.

Best Practices & Performance Driven

Implementing a streamlined and error-free orthopedic medical billing process is challenging. With our years of experience and knowledge, we create strategies to help organizations improve their clean claim rate and generate consistent cash flow. Furthermore, with our software agnostic approach, we are able to seamlessly integrate with your team and work for your practice immediately.

Reduced Costs, Increased Revenue & Maximized Profitability

Managing billing in-house is expensive. With our orthopedic medical billing services, not only do you save costs (such as salaries and benefits for staff, technology, hardware and training costs), but you also accelerate revenue due to timely claims submission and increased reimbursements. As a leading orthopedic billing company, we have no doubt that your profitability will improve significantly when you partner with us!

Orthopedic Revenue Cycle Management Services

Our team verifies benefits and coverage and obtains prior authorization (when required) for the type of orthopedic services you will be rendering. Verifying eligibility is not only important because it provides a clear understanding regarding insurance coverage, but it also determines patient’s responsibility to pay right from the beginning. Our eligibility verification and prior authorization can therefore help you reduce eligibility-related rejections and denials, increase upfront collections, and improve patient satisfaction.

Many orthopedic providers and internal teams struggle to remain updated with the constantly changing payer and coding guidelines. Our certified medical coders are well-versed in multiple code sets, including ICD, CPT and HCPCS, and modifiers, and are experienced in coding for the wide scope of services and procedures that orthopedic providers perform. You can rest easy knowing that your claims are coded accurately and to the highest level of specificity by our coding professionals.

Our orthopedic medical billing team streamlines the billing process by capturing patient demographics data, entering charges, submitting claims, and posting payments efficiently. Their experience and expertise ensure that your claims are submitted accurately and in a timely manner, while maintaining compliance, to help your organization achieve its revenue cycle goals. Not only do we improve your clean claim submissions, but we also mitigate any financial losses that could result from claim rejections or denials.

Nearly 25% of medical claims are rejected; but we can help reduce this! Our accounts receivable and denial management solutions are designed to increase revenue collections. We have an experienced team of collection specialists, who not only follow-up with insurance companies and check on whether accurate payments are received, but they also research unpaid claims, respond quickly to claim rejections and resubmit corrected claims. Furthermore, they also identify and categorize denial reasons and take necessary steps to prevent them from occurring again.

In orthopedics, denials due to poor documentation are quite common. Incomplete patient demographics, authorization errors and coding inaccuracies due to poor documentation can result in denials. Special attention must be paid to proper documentation before, during and after a patient visit, as any simple error or missed information, can result in missed opportunities for reimbursement. Our CDI services can help you capture patient data accurately, improve patient outcomes and significantly boost collections.

3Gen Insights

Our analytics help us nail down specific root causes of denials, which reduce repeated rejections of the same error in the future. Below are some common orthopedic claims denial reasons that we have identified based on our past experience. As you go through this list, you will find that these denials are in fact preventable!

Claim past timely
filing limit

Failing to demonstrate medical necessity

Incorrect use of orthopedic codes and modifiers

Lack of prior authorization

Missing/incorrect required claim information

Orthopedic Sub-Specialty Experience

  • Arthroplasty
  • Bone Health Center
  • Chiropractic
  • Foot and Ankle Surgery
  • General Orthopedics
  • Hand Surgery
  • Hip and Knee Surgery
  • Joint Replacement
  • Kinesiology
  • Occupational Therapy
  • Orthopedic Oncology
  • Orthopedic Trauma
  • Osseointegration Clinic
  • Pediatric Orthopedics
  • Physical Therapy
  • Physiotherapy
  • Podiatry
  • Shoulder and Elbow Surgery
  • Spine Surgery
  • Sports Medicine
  • Trauma Surgery
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