Orthopedic Billing and Coding the Long but Sure Road towards Profit

Orthopedic practices thrive on efficient billing practices that help in streamlining revenue cycle management by cutting out delays and minimizing stress on cash flows.

Here is a list of things you need to handle as efficiently as possible to avert claim denial at your orthopedic specialty clinic:

Insurance Cover Verification

Insurance cover verification is an important first step when you are trying to keep your orthopedics billing practices profiteering.  Pre-authorizing and verifying coverage provided by the insurance carrier of every patient needs to be performed to ensure they have active coverage for the type of medical services provided to them.

You also need to decipher the reports sent to you by their insurance company. This will help you understand whether or not their policy covers the kind of medical care catered to the patient, the practice also saves time and money by avoiding chances of denials and coverage issues that might have surfaced in the future. Hence, verifying insurance coverage is imperative for a sustainable orthopedic practice.

Verify Patient Information

As undeniable as it sounds verification of patient information is an imperative step in the billing process. Revisit the spelling of patient names, their date of birth, as well as other demographical details that are easy to overlook or misspell but can result in filing errors leading to denials of insurance claims later.

Appoint the administrative staff to go over intake forms that are filled out by patients so as to make sure the information received matches what you process on your claim. This small, seemingly insignificant step can go a long way in raising the bar of your profit by omitting the chances of facing denials.

Time-Bound Claim Filing

Timely filing of claims can be a mammoth step towards streamlining the revenue management cycle of your orthopedic clinic. You need to put in place a process, some standard procedures, and metrics to ascertain that claims are submitted within a stipulated time frame. You also need to keep up with the deadlines and time-bound filing limitations that insurance carriers prescribe. Meeting the deadlines on time can narrow down the chances of its rejection, ensuring healthy cash flows.

Be Code Conscious

In the case of orthopedic billing, claims stand a chance of being denied on the grounds that the codes used are not specific enough. Your staff needs to be in possession of all the information that is documented to justify the codes you have selected. There is also a need to make sure that the staff is using the correct codes for the procedure or service.

The newly introduced ICD-10 requires coding to be highly specific for it to be paid. There is a need for you to train your staff and provide the necessary resources and expertise for them to be able to document and code the claims to perfection. Medical auditing is a good way to discover areas of improvement for your coding staff. A little attention to codes and coding strategies can help you soar the revenues of your practice up.


There are instances where outsourcing the management of your orthopedic practice’s billing can in turn decrease the cost of operations of the clinic phenomenally, increasing the revenues all the while. Outsourcing lets your billing process be more efficient by preventing the delays that result from employee fallouts and turnover, decreases the overhead expenses, and maximize profitability.

Outsourcing orthopedic medical billing to specialists who understand the specific coding and billing guidelines for all aspects of orthopedic medical billing, including: Arthroscopic surgeries, Fracture repairs, and Spine surgeries and process claims applying specific codes and modifiers is the best way to increase the profits.