{"id":31980,"date":"2026-08-31T21:10:42","date_gmt":"2026-08-31T15:40:42","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=31980"},"modified":"2026-08-31T21:12:36","modified_gmt":"2026-08-31T15:42:36","slug":"orthopedic-ar-cleanup-before-year-end","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/orthopedic-ar-cleanup-before-year-end\/","title":{"rendered":"Is Your Orthopedic AR Ready to Close Out Before Year-End?"},"content":{"rendered":"

Probably not, and that’s normal. Most orthopedic groups and multi-surgeon facilities carry a meaningful chunk of orthopedic AR sitting past 90 and 120 days heading into Q4, largely because joint and spine procedures carry 90-day global billing periods, implant documentation delays, and workers’ comp cases that age slower than routine claims.<\/p>\r\n

The real question isn’t whether your AR is perfectly clean right now. It’s whether enough time remains before December 31 to work it down before the 12-month timely filing clock quietly closes on your oldest claims.<\/p>\r\n

If you manage finance or operations for an orthopedic practice, multi-OR surgery center, or spine group, this problem rarely shows up as one obvious red flag. Case volume looks healthy and claims are going out the door, yet a chunk of it from earlier this year is still sitting open with no deadline attached. Year-end is that deadline, whether your team has scheduled time for it or not.<\/p>\r\n

Why Orthopedic AR Ages Differently Than Other Specialties<\/h2>\r\n

Orthopedics isn’t billed like primary care or a routine outpatient visit, and that difference is exactly why this AR tends to run older than other specialties on a typical aging report.<\/p>\r\n

Major joint, spine, and trauma procedures carry a 90-day global surgical period under Medicare. CMS’s own Global Surgery guidance confirms the window actually runs 92 days total: one day of pre-operative care, the day of surgery, and 90 days of post-operative follow-up, all bundled into the original payment. Post-op visits, pain management, and suture or cast removal are already paid for inside that global fee. One miscoded post-op claim during that window can trigger a denial that sits unresolved for weeks.<\/p>\r\n

Add implant cost documentation, workers’ comp and personal injury liens that routinely stretch past 120 days, and prior authorization on hardware-heavy procedures that shift from state to state, and “normal” aging looks nothing like a family medicine practice.<\/p>\r\n

Generic medical billing services built for lower-complexity specialties weren’t designed for this; you can review orthopedic billing services available in your state<\/a> to see how coverage and requirements differ where you operate.<\/p>\r\n

Three Reasons This Backlog Piles Up Right Before Year-End<\/h2>\r\n
    \r\n
  1. Q4 surgeries are still inside their global period on December 31.<\/strong> A hip or knee replacement performed in October or November is still inside its 90-day window at year-end. If your team files a separate post-op claim by mistake, or misses a modifier on a related visit, it denies and lands right back in your open AR at the worst time to work it.<\/li>\r\n
  2. Implant and hardware costs get flagged for missing documentation.<\/strong> Payers increasingly ask for invoice-level proof of implant cost before releasing payment on high-dollar hardware. When OR logs, implant invoices, and the claim itself aren’t reconciled in real time, that one line item can hold up an entire claim for months.<\/li>\r\n
  3. Staff attention shifts to next year’s schedule before this year’s claims are closed.<\/strong> Every December, billing teams start prepping for January volume and updated fee schedules. Working the aging bucket down competes for the same hours, and it usually loses.<\/li>\r\n<\/ol>\r\n

    The 12-Month Filing Clock You Can’t Extend<\/h2>\r\n

    Medicare claims must be filed within 12 months, or one calendar year, from the date of service, under 42 CFR \u00a7 424.44, the regulation implementing Section 6404 of the Affordable Care Act. No appeal reopens a claim once that window closes, regardless of how valid it was or how clean the documentation is.<\/p>\r\n

    For an orthopedic practice, any claim from a procedure performed in the final months of last year is nearing that hard deadline right now. Most commercial payers set even shorter windows, often 90 to 180 days. Every month your AR sits unworked, you move closer to converting a collectible claim into a permanent write-off.<\/p>\r\n

    What the Latest CMS Rules Mean for Your Orthopedic AR<\/h2>\r\n

    Two recent CMS actions make year-end cleanup more urgent than usual this cycle.<\/p>\r\n

    First, CMS finalized a 2.6% ASC payment update for CY2026, effective January 1, 2026, and added 560 procedures to the ASC Covered Procedures List: 289 newly eligible procedures plus 271 codes removed from the Inpatient Only list. More joint and spine cases are shifting into ASC settings than before, meaning more claims now run through ASC-specific rules your team may still be learning.<\/p>\r\n

    Second, CMS’s proposed CY2027 Physician Fee Schedule sets the conversion factor at $32.84 for providers not qualifying for advanced APM participation, a 1.68% decrease from CY2026’s $33.40, effective January 1, 2027. Reimbursement per case is set to shrink next year, so recovering every dollar owed on this year’s claims matters more than it did twelve months ago.<\/p>\r\n

    Separately, HHS OIG’s ongoing DMEPOS review notes that Medicare payments for durable medical equipment, prosthetics, orthotics, and supplies already exceed $7 billion annually in traditional Medicare, keeping implant and hardware documentation under continued federal scrutiny. Loose implant documentation is now an audit risk, not just a collections problem.<\/p>\r\n

    Reactive Cleanup vs. In-House Effort vs. MBC-Managed Recovery<\/h2>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
    Factor<\/strong><\/td>\r\nReactive Year-End Push<\/strong><\/td>\r\nIn-House Manual Rework<\/strong><\/td>\r\nMBC-Managed Recovery<\/strong><\/td>\r\n<\/tr>\r\n<\/thead>\r\n
    Claim prioritization<\/td>\r\nWhatever staff gets to first<\/td>\r\nBy dollar amount, inconsistently<\/td>\r\nBy filing deadline and dollar value together<\/td>\r\n<\/tr>\r\n
    Global period claims<\/td>\r\nFrequently misfiled or resubmitted in error<\/td>\r\nReviewed case-by-case, reactively<\/td>\r\nTracked against the 92-day window automatically<\/td>\r\n<\/tr>\r\n
    Implant documentation<\/td>\r\nChased after a denial arrives<\/td>\r\nReconciled manually, often late<\/td>\r\nVerified against OR logs before submission<\/td>\r\n<\/tr>\r\n
    Timely filing risk<\/td>\r\nDiscovered only after a claim ages out<\/td>\r\nTracked in spreadsheets, inconsistently<\/td>\r\nAutomated alerts before the 12-month deadline<\/td>\r\n<\/tr>\r\n
    Typical recovery on aged balances<\/td>\r\n40%\u201355% of eligible amounts<\/td>\r\n55%\u201365% of eligible amounts<\/td>\r\n80%\u201390% of eligible amounts<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

    A Practical Checklist Before December 31<\/h2>\r\n

    Closing this out doesn’t require a department overhaul, just a focused sweep, in this order:<\/p>\r\n

      \r\n
    1. Pull every claim over 90 days by date of service<\/strong>, and separate anything still inside an active global period from everything else.<\/li>\r\n
    2. Flag claims over 300 days first.<\/strong> Those sit closest to the 12-month filing wall and need attention before anything newer.<\/li>\r\n
    3. Reconcile implant invoices against OR logs<\/strong> on every open high-dollar hardware claim before resubmitting or appealing.<\/li>\r\n
    4. Confirm workers’ comp and personal injury liens<\/strong> have current adjuster contacts and documented case status, since these are the claims most likely to sit forgotten.<\/li>\r\n
    5. Set a hard internal deadline<\/strong>, two to three weeks before year-end, to have every claim resubmitted, appealed, or formally escalated.<\/li>\r\n<\/ol>\r\n

      How MBC Recovers Aging AR for Orthopedic Practices<\/h2>\r\n

      At Medical Billers and Coders<\/strong>, cleaning up orthopedic AR isn’t a once-a-year scramble. Our orthopedic billing services<\/a> are built around the specialty’s real complexity: global period tracking, real-time implant cost reconciliation, and dedicated workers’ comp and personal injury follow-up, instead of a generic aging report that treats every claim the same way.<\/p>\r\n

      This sits inside a broader revenue cycle management model that pairs specialty-specific medical billing and coding services with dedicated old AR recovery services<\/a> for claims already past 120 or 180 days, where most internal teams run out of bandwidth.<\/p>\r\n

      Practices weighing a switch can review our transparent, outcome-based pricing model<\/a> to see how our RCM services scale with claim volume, no long-term lock-in required. As part of our state-wise medical billing services across every U.S. market<\/a>, we tailor payer rules and filing windows to wherever your facility operates.<\/p>\r\n

      Summary<\/h2>\r\n

      Orthopedic AR doesn’t age the way other specialties’ claims do, and pretending otherwise is how facilities let recoverable money slip past the 12-month filing deadline every year. The 90-day global period, implant documentation demands, and workers’ comp complexity mean your oldest claims need attention now, not in January.<\/p>\r\n

      With CMS shifting more high-acuity procedures into ASC settings under the CY2026 rule, and proposing a lower Physician Fee Schedule conversion factor for CY2027, every dollar sitting in aged AR is worth more to your facility this year than next. A focused sweep before December 31, built around actual filing deadlines rather than a general aging report, is what separates facilities that close the year clean from those still chasing last year’s claims in March.<\/p>\r\n

      Ready to Close Out Before Year-End?<\/h2>\r\n

      Request a complimentary orthopedic AR audit from Medical Billers and Coders<\/strong> and get a clear, claim-level breakdown of what’s still recoverable before the filing clock runs out.<\/p>\r\n

      Call us at 888-357-3226<\/a><\/strong> or email info@medicalbillersandcoders.com<\/a><\/strong>\u00a0to schedule your review this week.<\/p>\r\n

      FAQs: Orthopedic AR<\/h2>\r\n\r\n
      \r\n
      1. What counts as “old” orthopedic AR?<\/strong><\/strong>\r\n

      Most facilities treat anything over 90 days as aging and anything over 120 days as high-risk, since that’s typically when commercial payer appeal windows start closing and recovery odds drop sharply.<\/p>\r\n<\/div>\r\n

      2. Can a claim still inside its 90-day global period be billed separately?<\/strong><\/strong>\r\n

      Only for services specifically excluded from the global package, like an unrelated new problem or a complication requiring a return to the OR. Routine post-op visits are already bundled into the original payment.<\/p>\r\n<\/div>\r\n

      3. What happens if a Medicare claim passes the 12-month filing deadline?<\/strong><\/strong>\r\n

      Under 42 CFR 424.44, the claim generally becomes permanently unpayable, with very limited exceptions. That’s why claims nearing one year old need priority over newer, lower-risk balances.<\/p>\r\n<\/div>\r\n

      4. Why is implant documentation such a common holdup in orthopedic billing?<\/strong><\/strong>\r\n

      Payers increasingly require invoice-level proof of implant cost before releasing payment. When OR logs aren’t reconciled with the claim in real time, that missing detail can delay an otherwise clean claim for months.<\/p>\r\n<\/div>\r\n

      5. Is year-end cleanup different from regular denial management?<\/strong><\/strong>\r\n

      Yes. Denial management responds to claims already rejected. Year-end cleanup is broader, also targeting claims still unworked or unappealed before they age past a recoverable deadline.<\/p>\r\n

      Sources:<\/strong><\/p>\r\n