How Specialized Billing Service Helps Prevail Over Unique Orthopedic Billing Challenges

Orthopedic billing has its own share of challenges that seem to get complex with changes in orthopedic-specific CPT codes and modifiers every year or as deemed fit whenever by the governing body for monitoring and recommending coding changes. Quite parallel to this challenge is the orthopedic fee schedules (published by the CMS), which are progressively becoming smaller every year. In between these two, orthopedic billing and coding environment continues to be influenced by technology so much so that it is virtual impossible to conduct operational functions without being compliant with the requisite degree of automation. The sum total of these three challenges puts so much pressure on orthopedic physicians that they are left with no option but to entrust their orthopedic billing to specialists outside their clinical facilities.

Orthopedic medical billing specialists can bring a host of services to the table, notably of which are:

  • Medical coding
  • Medical billing
  • Denial management
  • Complete AR Follow up
  • Weekly and Monthly reports
  • Feedback to providers

This array of value-added services can translate into real benefits to providers, such as:

  • Decline in account receivables; orthopedic facilities can expect to realize their claims within 60 days from the day of submitting claims either electronically or manually through paper submission.
  • Opportunity to focus intensively on patient care as the operational side is entirely looked after by orthopedic billing specialists
  • Uninterrupted claim reimbursements as changing coding regulations are handled by orthopedic specialist coders.
  • Availing patient billing statements to verify against the actual submission of patient claims.
  • Getting denied claims resubmitted with necessary supportive documents or having them appeal and adjudicated with attorneys concerned.

Therefore, it is vital that orthopedic facilities or physicians source services from orthopedic medical billing specialists that are acquainted with evolving changes in orthopedics codes and payer requirements, which will ensure that your claims are submitted accurately in time to have them reimbursed as early as possible. Amongst the traits that define orthopedic billing specialists are their being knowledgeable of:

  • Complex orthopedics billing codes and rules
  • Orthopedics-related terminology
  • Office notes and operative notes
  • Coding for surgical procedures
  • Code variations related to multiple procedure rules

While orthopedic physicians may be required to assess their prospective orthopedic billing specialists’ competence, offers them ready pool of resources that have verifiable credentials for being consistent with evolving orthopedic medical billing practices and technology systems. Thus, orthopedic physicians can expect to have:

  • Their account receivables managed effectively
  • Access to round-the-clock claim processing
  • Patients’ insurance verified through system-based eligibility
  • Their medical billing updated consistently with coding updates as and when they occur
  • System-based claims scrubbing
  • Addressing billing-related issues over secure, sophisticated, and swift communication network
  • Quality assurance checks conducted at regular intervals
  • Weekly or fortnight progress reports on claims under process
  • Their orthopedic reimbursements maximized as far as possible
  • Their practices compliant with HIPAA standard for ‘Meaningful Use of EHR’, which has come to be recognized as the yardstick for measuring orthopedic physicians’ competence for clinical and operational excellence