To choose the best orthopedic billing services, look for a partner staffed by certified orthopedic coders who track global surgery periods claim by claim, apply modifiers correctly the first time, report denial rates and days-in-AR every month, and price their service as a percentage of what they actually collect for you. A generalist billing vendor […]
Probably not, and that’s normal. Most orthopedic groups and multi-surgeon facilities carry a meaningful chunk of orthopedic AR sitting past 90 and 120 days heading into Q4, largely because joint and spine procedures carry 90-day global billing periods, implant documentation delays, and workers’ comp cases that age slower than routine claims. The real question isn’t […]
Yes, for most procedure-heavy orthopedic groups, the CY 2026 Medicare Physician Fee Schedule quietly reduces orthopedic reimbursement even though the headline conversion factor went up. CMS finalized a 3.26% to 3.77% increase to the conversion factor for 2026, but it paired that increase with a −2.5% “efficiency adjustment” applied to work RVUs on nearly every […]
Orthopedic AR cleanup is the process of identifying, prioritizing, and resolving claims stuck in accounts receivable past 90–120 days, usually workers’ comp liens, prior-auth gaps, or global period bundling denials, before they age into write-offs. For a multi-surgeon orthopedic group, that “stuck” bucket is rarely a handful of claims. It’s often six figures a year […]
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 […]
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