{"id":2025,"date":"2013-03-28T11:02:49","date_gmt":"2013-03-28T11:02:49","guid":{"rendered":"http:\/\/www.medicalbillersandcodersblog.com\/?p=2025"},"modified":"2025-06-04T15:25:50","modified_gmt":"2025-06-04T15:25:50","slug":"insurance-underpayments-the-issue-that-is-plaguing-orthopedic-billing-the-most","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/insurance-underpayments-the-issue-that-is-plaguing-orthopedic-billing-the-most\/","title":{"rendered":"Insurance Underpayments, the Issue That is Plaguing Orthopedic Billing the Most"},"content":{"rendered":"

Insurance underpayments continues to be a major concern for medical practices across the United States; more so for orthopedic surgeons, who, despite serving in a more critical specialty, find it hard to fully recover their medical cost. Because most of the orthopedic procedures happen to be highly expensive, even a marginal percentage of insurance underpayments might turn out to be a major drain on practitioners\u2019 revenue, which could severely spoil clinical and operational efficiency.<\/p>\n

With orthopedic surgeons\u2019 insurance underpayments touching an all-time high of 10 percent and potentiality to reach 20 percent, it may be time that orthopedic surgeons relooked at their medical billing practices<\/strong> and process, and aggressively track and resolve their underpayments.<\/p>\n

It is encouraging that significant portion of these underpayments (as high as 7 to 10 percent) can easily be made good with a refined and robust orthopedic-specific medical billing.<\/p>\n

While most of the underpayments may be linked to refusal by the insurance carriers, the root-cause may be inherent in orthopedic surgeons\u2019 medical billing policies and procedures: Orthopedic Billing<\/strong><\/a><\/p>\n\n\n\n\n\n\n\n\n\n\n
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  • To begin with orthopedic surgeons<\/strong> may have not been enrolled and approved by insurers.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
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  • They may not have taken due diligence in verifying patients\u2019 eligibility for services prior to the actual appointment; there could have been lack of technology integration with practice management system to verify coverage for patients\u2019 orthopedic procedures.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
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  • Orthopedic surgeons may have not been cautious in seeing pre-authorization or precertification, in the absence which payers are automatically authorized to reject payments for\u00a0 procedures and services even if they have been proved to be medically necessary.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
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  • Orthopedic surgeons\u2019 staff may have left deductible or coinsurance uncollected from patients.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
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  • Major portion of patients may have been Medicare and Medicaid beneficiaries, whose reimbursements are lower than most of the popular commercial insurance plans.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
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  • There could have been coding errors (either under-coding or over-coding) due to coding staff\u2019s incompetence. And with orthopedic coding<\/strong> likely to be more complex and vast post ICD-10, the scope for coding may be even more.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
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  • There could have been considerable in claim submission, so much so that insurance payers could reject them on grounds of being too late to be accepted.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
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