August 10, 2015
The last five to ten years have seen a lot of trends and changes taking place in the reimbursements of orthopedic professionals which has impacted the orthopedic industry greatly. There has also been a reduction in reimbursement by Medicare and Medicaid. Moreover, third-party payers like Aetna, Cigna, etc. have negotiated fee-for-service contracts with physicians resulting in reimbursement at less than 100 percent of charges. Furthermore, HIPAA have tightened claims data submission requirements which makes reimbursements that much more difficult. Adding to it the government’s emphasis on healthcare fraud and abuse has resulted in tightening the compliances which has increased the importance of accurate billing. Adding to that is the impending implementation of ICD – 10 which will require the orthopedics to bill keeping in mind the new codes which will make reimbursements a tad difficult. In view of such issues, orthopedic practices are striving to improve their revenue cycle processes.
The global orthopedic devices market is set to reach an estimated US $ 41.2 billion in 2019 which means it will grow at about four percent per annum. The increase in elderly population and the increased risk of osteoporosis, osteoarthritis, bone injuries and obesity will contribute to the growth of the orthopedic device market. Knee and hip devices account for a large market share in the orthopedic device market. The major players in this industry are DePuy Synthes, Zimmer and Stryker and so on.
Another interesting piece of information according to the American Academy of Orthopedic Surgeons states that about 28.6 million people in the United States of America sustain some type of musculoskeletal injury annually which costs about $ 254 billion. Many orthopedic reconstruction and trauma device manufacturers have experienced significant growth due to this.
Steps to improve revenue
These are the steps orthopedics can take to improve revenue:
Provide training: management should take steps to provide proper training to the staff so that they become more adept at billing and coding. This will also help in streamlining the revenue process and eliminate unnecessary procedures
Specialized services: orthopedics can provide services to a specialized sector. They can tie up with sport institutes or sport bodies and provide specialized services to sport-persons who are prone to attaining muscular injuries
Eradicating costs: another vital step is to remove all extra costs. Any expense incurred which has no significance will lead to a loss in revenue
Outsourcing billing services: a smart move would be to outsource orthopedic billing and coding service to an expert who can take care of the billing. What with the ICD transition coming up billing will see a bit of hiccoughs so it will make sense to pass on this responsibility to an expert who is abreast with the changes
Getting paid in the first attempt: chances are that if the claim is rejected then probability of getting paid reduces significantly. Orthopedics should make sure that their team gets the claims right the first time so that they can get paid in the first attempt itself
Best Billing and Coding Practices