Specialities
To manage orthopedic bundled payments, reduce patient risk before surgery, track episode costs in real time through a strong data system, analyze cost and outcome variation to cut waste, meet CMS quality measures, and align surgeons, nurses, and post-acute providers around the episode of care. Because CMS reconciles episode costs retrospectively, often months later, a […]
No, orthotics and orthopedics are not the same. Orthopedics is a branch of medicine that diagnoses and treats conditions of the skeletal system, including bones, joints, and tendons, while orthotics refers to devices such as braces and inserts that support, align, and stabilize a weakened or injured body part. They are also billed differently: orthopedic […]
Coding for open fracture debridement uses CPT 11010, 11011, or 11012, chosen by the deepest tissue debrided: skin and subcutaneous tissue, muscle, or bone. These codes apply only when an open fracture or dislocation is present; otherwise the 11042–11047 series is used. Basics of Open Fracture Debridement Debridement is used to remove foreign material or […]
Workers’ compensation billing is the process of billing an employer’s workers’ comp insurer, not the patient’s health plan, for treatment of a work-related injury or illness. Providers submit a CMS-1500 claim with the date of injury, the workers’ comp claim number, and supporting documentation, and follow fee schedules set by each state’s compensation board. Workers’ […]
COVID-19 has impacted the day-to-day life of people, businesses, manufacturers, and even the healthcare industry. COVID-19 pandemic has also affected the orthopedics field by which doctors are not effectively concentrating on their regular patients. The shortage of physicians and support staff and even the ventilators, medicine, and other equipment and devices are the major concerns […]
The most common challenges orthopedic surgeons face are high implant costs that payers often reimburse below cost, rising equipment expenses when each surgeon prefers different products, and billing and coding errors that delay or deny claims. Surgeons and orthopedic centers manage these by justifying implant choices against reimbursement, standardizing equipment to negotiate better pricing, and […]
The Center for Medicare and Medicaid Services (CMS) has issued the final rules on Ambulatory Surgical Center (ASC) reimbursement and changes that could have important implication on the orthopedics billing in ASC. The rule includes update to payment policies, payment rates and also the quality provisions for the services provided under the Physician Fee Schedule […]
With a fleet of changes in ICD-10 and updates, 2018 can be a troublesome year for orthopedic practitioners. If your ICD-10 orthopedic coding is not up to the mark, you are likely to suffer on the reimbursement front. Most of the changes in CPT 2018 have been made to the Musculoskeletal System codes (20005-29999) and […]
To avoid denials in orthopedic billing, verify insurance coverage before every visit, confirm patient demographics and provider NPI on each claim, keep CPT, HCPCS, and ICD-10 codes and modifiers current, check Local Coverage Determinations for payer-specific rules, and scrub claims before submission. Demographic errors alone drive 30–40% of orthopedic denials, so most denied claims are […]
The term ‘Healthcare Rationing by Hassle’ as touted by some surgeons showcases the stress caused by numerous changes in the healthcare industry. Orthopedics practice like all others feels the pressure of high costs, new ICD-10 code concerns, low and delayed reimbursements, declining margins, high deductibles, insurance/payer policy amendments, regulations, and other reforms. To combat this […]
Connect with us by filling out this form. Let’s tailor a
solution that fits your needs perfectly.
Services
Resource Center
Pricing
About
Contact
