How to Improve Revenue for Orthopedic Billing Services?

There are 28,000 Orthopedic Surgeons practicing across the US, according to the American Academy of Orthopedic Surgeons Even though Orthopedists earn the most from patient care work ($421,000), as compared to physicians from other specialties (Medscape Physician Compensation Report 2015), yet today the orthopedic practice seems to be facing big challenges in terms of generating revenue including from the changes brought in by the various health reform acts. With an aging population in the US coupled with an increase in federal spending on health care, Medicare spending for orthopedic services has, however, shown no change.

This doesn’t paint a rosy picture for orthopedics. It is well known that practices that lose more than 20 percent of their potential revenue are doing so because of inept medical billing processes. Moreover, in orthopedic billing services, due to rules associated with various multiple procedures, tracking of underpayments is crucial, as these payments can increase revenue collection by 7 to 10%. So, how can you get a robust revenue cycle management system going without compromising on your core practice?

So if you are wondering how to improve revenues for your orthopedic practice, then you have come to the right place to pick up a few tips.

Improve Management:

Streamlining most processes and sending specific people for training in specific tasks thereby decentralizing the management will help improve better patient satisfaction and thereby bring in more footfalls, increasing revenue.

Aligning with the trends:

Bringing in or aligning with a specific area of expertise such as sports medicine or in-house physical therapy (PT) programs can bring in additional revenues for a hospital or even private clinics. A single orthopedic surgeon service was known to have contributed an estimated $2,111,764 as revenue to a hospital service in a 2010 survey.

Reduce Overheads:

Clerical demands of managed-care insurance plans, such as insurance verification and pre-authorizations can all be outsourced instead of dealing with this in-house.

Add-on ancillary services:

The Medscape report showed that the start of new ancillary services rose from 19% of physicians in 2013 to 21% in 2014. These services can have a profit margin of 50-70 percent jump in your revenue. About one-third (31%) of orthopedists offer ancillary services (Orthopedists, are also at the top of the list for compensation from non–patient care activities earning $29,000). They include an in-office surgical center, pain management services/center, MRI, physical therapy with orthotics and braces, or even an occupational health department.

In-House Physician(non-operative orthopedist):

This helps increase direct revenue by

  • Giving room to the main principals to perform surgery which brings in higher reimbursement.
  • Helping with ancillary services like pain management and pre-surgical medical clearance.
  • Handling office procedures giving more time for the orthopedist to concentrate on core practice.


Outsourcing orthopedic billing services can help reduce a lot of extra work, especially with the transition from the ICD-9 to ICD-10 coding systems.

Overall, in the future, with the changing healthcare reforms, and the opening up of Medicare facilities for uninsured patients, and an increase in surgical and medical interventions, there will soon be a need for niche specialties, and orthopedists will need to rise to these demands.

Knee replacements, one of the most sought-after elective surgeries have helped boost orthopedists revenues, and more such procedures are bound to follow. Are you ready?

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