Orthopedic Billing is one of the most important functions of a practice's revenue cycle. With proper checks during billing, a practice can have regular income without any delays, thus minimizing stress and cash flow issues.

It's important to keep several checkpoints in your medical billing cycle to ensure billing is done effectively and to minimize the chance of claim denials.

Following are some of the checkpoints:

Recheck Patient Information:

It's better to reiterate a patient's details such as the spelling of the patient's name, and their date of birth that is easy to misspell or overlook. All these minute details, if gone wrong, may result in the rejection of the claim. It's important to train your front desk or administrative staff to take a minute or two and review all the details that your patients fill out to make sure the information that is received is consistent with what will be processed on the claim.

Verify Insurance Coverage:

To keep your orthopedic billing efficient and profitable, it's important to take time and verify all the aspects of insurance. Ensures your patients have active coverage for the medical services you will be rendering. Verifying the insurance coverage can save your time, effort, and money by preventing coverage issues and claim denials. Also, make sure you understand the reports send by their insurance company so that you are aware whether or not their policy covers the kind of medical care you are providing.

Get a copy of the Patient's Insurance Card:

Even if the patient states that insurance hasn't changed, it's a good idea to ask for a copy of the insurance card. Keep an updated image of both sides of the card in your electronic health record which will also provide informational backup in case someone mistyped insurance information in the record.

Contact the insurance provider:

It's advisable to contact the insurance company directly to verify eligibility data instead of taking the information on the card at face value.

Timely Claim Filing:

Be aware of the deadlines to fill the claims. Create a process, standard procedure, and a checklist to ensure the claims are submitted within the deadlines. Meeting these deadlines may create that difference between a paid claim and a denied claim.

Use specific codes:

Many a time, claims are denied on the grounds that the codes used are not specific enough. Not only does your practice should use the correct codes for procedures and services but should also have as much information as possible documented to justify the codes selected. A switch to ICD-10 requires coding to be more specific in order to be paid, that means if your orthopedic billing and coding procedures are not compliant with the new system and coding standards, you will not be paid completely for your services.

Be sure that your billing staff and providers have the necessary expertise and resources required to document and code accurately and with the highest level of specificity for your claims.


It may seem as an additional cost but outsourcing the management of your practice's billing and revenue cycle actually decreases costs while increasing the revenue stream. It saves your practice and staff time and effort for re-filing claims that have been denied.

Outsourcing your billing management can actually save you from the slowdown that occurs with an in-house billing staff such as off-days due to vacations and illness and also protects you against the hassles of employee turnover.

To ensure you are compensated properly for all the valuable work you provide, your medical billing should be completed accurately and in a timely fashion.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. To know more about our Orthopedic billing and coding services contact us at

Published By - Medical Billers and Coders
Published Date - Apr-11-2017 Back

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