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.
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.
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
Schedule a consultation with our experts today.
