Modifier 25 vs Modifier 57 comes down to one question: is the same-day E/M visit tied to a minor procedure (0- or 10-day global period) or a major procedure (90-day global period)? If it’s minor, you append Modifier 25. If the visit is where the surgeon first decides to operate on a major case, Modifier […]
Old AR Recovery in Orthopedics is the process of auditing, appealing, and collecting orthopedic claims that have aged past 60, 90, or 120 days because of NCCI bundling edits, missing modifiers, or global period errors, before they cross the payer’s timely filing deadline and become permanently uncollectible. For a busy orthopedic group, this backlog isn’t […]
Orthopedic billing denials are rising in the second half of 2026 mainly because of three converging forces: the CY 2026 Medicare Physician Fee Schedule’s efficiency adjustment and practice expense cuts, sharper OIG scrutiny of modifier 25 use, and expanding prior-authorization requirements for implant-heavy and device-based procedures. Practices that haven’t updated their coding and documentation workflows […]
If your orthopedic billing company is not actively identifying and closing accounts receivable (AR) gaps at mid-year, you are most likely sitting on tens of thousands of dollars in stalled or written-off revenue. The direct answer: most orthopedic billing companies are reactive, not proactive. They process claims but do not engineer the recovery infrastructure needed […]
Joint replacement prior auth denials are costing orthopedic groups far more than they realize. A single denied CPT 27447 (total knee arthroplasty) puts $11,400 or more in at-risk revenue. Multiply that across even a modest surgical volume, and the annual loss becomes a CFO-level problem, not a billing office inconvenience. Medicare Advantage plans denied 7.4% […]
Orthopedic Revenue Integrity is the practice of ensuring your group actually collects every dollar it has contractually earned — and in 2026, most high-volume groups are failing at it without realizing it. Seeing more patients is no longer enough. Many busy orthopedic practices are generating record case volumes while quietly losing 12% to 22% of […]
Best Orthopedic Billing Companies 2026: Medical Billers and Coders (MBC) Coronis Health AdvancedMD RCM CareCloud Tebra (formerly Kareo) Choosing among the best orthopedic billing companies in 2026 isn’t a vendor selection exercise — it’s a margin protection decision. Multi-surgeon orthopedic practices and ASCs face a compounding revenue problem: implant cost leakage, global period documentation gaps, and […]
Orthopedic billing denials are costing practices between $200,000 and $500,000 in lost revenue every year, and most of it is preventable. The fix starts with understanding exactly which denial triggers are hitting your claims and putting the right systems in place before the claim ever leaves your office. Here is what you need to know. […]
Best Orthopedic Medical Billing Companies 2026: Medical Billers and Coders (MBC) Coronis Health AdvancedMD RCM CareCloud Tebra (formerly Kareo) Orthopedic billing is not general medical billing with harder codes. It is a distinct revenue cycle discipline where modifier errors, global period tracking failures, and implant documentation gaps routinely generate $150,000–$500,000 in annual uncaptured revenue for […]
Yes — Algorithmic Downcoding is silently stripping $12,000 to $30,000 per orthopedic surgeon annually, and most practices don’t see it happening until the damage is already done. If your case volume is steady but your reimbursements keep shrinking, the culprit isn’t your coding team. It’s a software system your payer built specifically to reduce what […]
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