Orthopedics
Express Care Virtual Visits: You don’t need an appointment. You’ll be connected to a provider who can help you with any number of common healthcare concerns.
Expert Orthopedic Billing Services That Maximize Your Practice’s Revenue and Efficiency
Tailored billing solutions for orthopedic practices—reducing denials, accelerating payments, and ensuring accuracy for every claim.We specialize in providing comprehensive billing services for orthopedic practices. Orthopedic procedures, from joint replacements to sports injury treatments, require specialized knowledge of codes, payer requirements, and documentation. These complexities make orthopedic billing a challenge—but one we’re equipped to solve.
98% First-Pass Pay Rate
Our expertise in orthopedic coding and payer-specific guidelines ensures that the majority of your claims are approved on the first pass, minimizing delays and speeding up payments
30% Reduction in AR Days
Our efficient billing processes and proactive follow-up reduce your practice’s accounts receivable days, improving cash flow and ensuring timely reimbursement.
15% Revenue Increase
By optimizing your coding, reducing denials, and negotiating better reimbursement rates, our clients have seen an average revenue increase of over 20%.
99% Claim Accuracy
Our attention to detail and expertise in orthopedic billing ensures that all claims are accurate, reducing rejections and accelerating payments.
Common Billing Challenges in Orthopedics
challenge
Complex CPT and ICD-10 Coding
Orthopedic procedures often involve complex coding for both surgical and non-surgical treatments, including joint replacements, fractures, and diagnostic tests. Correctly coding these procedures is essential to ensure accurate billing and prevent claim rejections.
How We Solve It:
Our team of certified coders specializes in orthopedic coding, including complex CPT and ICD-10 codes for a variety of conditions such as fractures, musculoskeletal disorders, and joint replacements. We ensure your procedures are properly documented and coded, minimizing the risk of errors and maximizing reimbursement.
challenge
Multiple Payer Guidelines and Contracts
Orthopedic practices typically work with a range of insurance payers, each with its own billing rules, reimbursement rates, and coverage guidelines. Managing multiple payer contracts and ensuring compliance with each can be challenging and time-consuming.
How We Solve It:
We streamline payer contract management, ensuring compliance with each payer’s rules and guidelines. Our team stays up to date with the latest payer requirements, ensuring that every claim is submitted according to the correct payer-specific rules. This minimizes errors and ensures timely payment.
challenge
High Volume of Claims and Procedures
Orthopedic practices deal with a high volume of claims, especially when it comes to joint replacement surgeries, fractures, and other common orthopedic procedures. Managing this volume while ensuring accuracy can be overwhelming.
How We Solve It:
We use advanced billing software and automation to efficiently manage high volumes of claims. Our team ensures that each claim is processed accurately and submitted on time, reducing the administrative burden and improving your practice’s cash flow.
challenge
Claim Denials and Underpayments
Denied or underpaid claims are a common issue in orthopedic billing, often due to coding errors, missing documentation, or disputes over medical necessity. These issues can delay payments and affect your revenue cycle.
How We Solve It:
We specialize in denial management, quickly identifying and addressing the root causes of denials. Our team works proactively to resubmit claims, appeal denials, and follow up with payers to ensure your practice receives the full reimbursement it deserves.
challenge
Complex Billing for Surgical Procedures
Orthopedic surgeries, such as joint replacements and arthroscopies, often involve multiple stages, procedures, and varying levels of reimbursement based on the payer. Ensuring proper billing for these complex procedures is critical.
How We Solve It:
We have deep expertise in billing for orthopedic surgeries. We handle the complexities of bundling and unbundling procedures, ensuring that each stage of the surgery is billed appropriately. Our team is proficient in managing the nuances of surgical billing, ensuring full and accurate reimbursement for each procedure.
How We Solve Orthopedic Billing Challenges
Specialized Orthopedic Coding
Our certified coders are experts in orthopedic-specific CPT, ICD-10, and HCPCS codes, including codes for fractures, joint replacements, diagnostic imaging, and more. We ensure that every procedure is accurately documented and correctly coded to reduce the risk of errors and maximize reimbursement.
Payer Contract Management & Negotiation
We manage your payer contracts to ensure that all claims comply with the specific rules and guidelines of each insurance company. Our team also works to negotiate better reimbursement rates and terms with payers, helping you improve your practice’s bottom line.
Efficient Claims Submission & Follow-Up
We streamline the claims submission process, ensuring that all claims are submitted quickly and accurately. Our team follows up with payers on any outstanding claims, resolving issues efficiently to minimize delays and improve cash flow.
Proactive Denial Management
We take a proactive approach to denial management. Our team monitors rejected claims, identifies the causes of denials, and works to resolve issues promptly. We submit appeals when necessary and follow up until the claim is paid in full, reducing your practice’s accounts receivable days.
Surgical Billing Expertise
We handle the complexities of billing for orthopedic surgeries, including joint replacements, arthroscopies, and fracture repairs. Our team ensures that all surgical procedures are billed accurately and in compliance with payer guidelines, ensuring full reimbursement for all services provided.
Compliance and Documentation
We ensure that all medical necessity and evaluation and management (E/M) documentation is complete, accurate, and compliant with payer and regulatory requirements. This helps your practice avoid audits and ensures that you are reimbursed properly for all services rendered.
