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Essential Tips to Make Orthopaedic Medical Billing Efficient

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The efficient and smooth running of the revenue cycle is essential for every practice. Similarly, orthopaedic specialities need to make sure that their billing is on the right path. By making the RCM effective and results-oriented, speciality practices can optimise workflows and get timely reimbursements. Also, it helps to reduce claim denials and decrease the accounts receivable backlog of practices. To maintain a seamless orthopaedic medical billing process, providers need to focus on improving the end-to-end RCM process. As a result, orthopaedic speciality owners can minimise payment delays, make workflows efficient, and improve their cash flow.

There are several services and treatments orthopaedic specialists offer to their patients. Similarly, orthopaedic speciality owners need to make sure their revenue cycle is efficient. Failing to do so, they may suffer with significant revenue losses in the form of claim denials. In addition, the services have a wide scope and proactive management of billing is extremely important to streamline payments. Also, hiring orthopaedic billing services can solve these problems of denials and make the RCM cycle efficient. So, using accurate codes to bill for services leads to faster reimbursements from payers and allows providers to get financial success.

Maintaining successful orthopaedic practices requires focus and attention to all aspects of the revenue cycle management. Also, the billing team needs to understand the billing software to ensure smooth workflows and correct clinical documentation. Likewise, it is essential to stay on top of the whole process from claim submission to getting final payments. However, leaving any loophole in the process may result in claim denials which pose a threat to the revenue cycle. So, providers can outsource billing services for orthopaedic treatments to third-party billing companies. As a result, It enables providers to focus fully on patient care. Here are some essential tips to optimize the billing process:

Eligibility and verification

Verifying patients’ benefits and eligibility are essential components to deciding whether to offer services or not. Similarly, orthopaedic speciality providers should know the treatments performed are covered by the patient’s insurance. If physicians offer services not covered under the patient’s insurance, it leads to claim denial. So, it is mandatory to make sure that services are offered according to the insurance coverage of patients. As a result, it helps to streamline payments from insurance companies, especially commercial payers. Prior authorization can help providers get authentic information about the insurance coverage of patients.

Medical coding

Medical coding challenges are the most common phenomenon related to claims submissions. Similarly, inefficient documentation and not keeping track of services offered properly may lead to incorrect coding. As a result, the orthopaedic medical billing process is compromised and providers may suffer revenue leakages. Also, the billing teams should stay updated with the latest coding guidelines to ensure clean claim submissions. Practice staff is mostly responsible for documentation because providers are busy offering treatment to patients. So, physicians should make sure that the clinical documentation is correct because error-free coding leads to seamless payments. However, outsourcing medical coding to experts can solve their problems. Third-party billing companies have a team of professional coders who can manage to code efficiently. As a result, orthopaedic specialities do not lose out on revenue due to incorrect claims.

Meeting industry criteria

As there are defined medical codes for other specialities, orthopaedic providers need to submit ICD-10 codes for reimbursements. In addition, correct codes ensure a seamless billing process for orthopaedic practices and help get paid on time. Also, adhering to the latest billing and coding guidelines help physicians optimize the revenue cycle process. Hiring orthopaedic billing services allows providers to focus on patient care and let experts handle the RCM cycle. Other than that, it results in augmenting revenue growth and accelerated payments from insurance payers.

As there are many procedures orthopaedic specialists perform, the billing and coding are different for every service. Generally, providers running an orthopaedic practice deal with problems in bones, tendons, ligaments, and muscles. Also, there are separately defined codes for every type of service orthopaedics may offer. So, managing the revenue cycle complexities with billing services for orthopaedic specialists leads to consistent cash flow.

Orthopaedic medical billing modifiers

To elaborate medical claims for the understanding of insurance payers, modifiers are used with codes. In addition, modifiers add clarity to the services and procedures performed by orthopaedic surgeons. Likewise, adding accurate orthopaedic modifiers with claims ensures smooth reimbursements from payers. So, using correct modifiers help practices avoid claim denials, get more revenues, and improve the bottom line. These modifiers are used in two different levels:

  • Level I. AMA regulates these CPT modifiers and these care numeric codes. Similarly, these modifiers provide details of the services orthopaedic providers offer.
  • Level II. These HCPCS modifiers appear as alphanumeric characters of two digits. CMS updates these modifiers every year.

Accounts receivables and denials

Reducing the accounts receivable backlog with effective denial management helps to avoid potential revenue losses. In addition, providers can hire orthopedic billing services to ensure clean claim submissions and a better first-pass rate. Similarly, physicians can achieve greater revenues and strengthen their practice financially. Also, it reduces the risks of losing money and leads to smooth cash flow. Not managing AR effectively leads to an inefficient revenue cycle. So, billing companies have AR specialists who keep track of payments and continuously follow up with payers. A substantial reduction in accounts receivable is possible by keeping track of claims and finding the root causes of denials.

Navigating through evolving healthcare industry

The healthcare industry is ever-evolving and keeps on regulating the revenue cycle settings for providers. In addition, staying afloat in the complex industry depends on how quickly and easily practices adapt to the changes. Similarly, compliance with HIPAA regulations and other regulatory standards helps healthcare providers avoid penalties and thrive financially. So, opting for billing services for orthopaedic specialities enables practitioners to navigate through the evolving healthcare industry. The billing companies possess skilled and trained professionals who drive the RCM success for orthopaedic practices. Further, staying aligned with the latest changes in the industry rules helps physicians to get fully paid on time.

Follow the performance-driven approach

Executing a process of billing and coding without errors is a challenging process. Also, providers can work with experienced billing companies which can help improve the revenue cycle. Instead of spending time and money on the in-house teams, orthopaedic speciality practices can outsource billing to experts. In addition, providers should follow a performance-driven approach to streamline the RCM cycle and keep a vigilant eye on workflows. Enhanced operational efficiency, effective denial management, and improvement in cash flow are possible with the right approach. So, hiring experts for streamlining practice operations and optimising the revenue cycle leads to financial success.

Optimise profitability of orthopaedic speciality

Improving the health conditions of patients is the most important concern of every practice. However, offering services and not getting full reimbursements from payers is stressful. In addition, profitability is also one of the major aspects providers cannot ignore. Also, the hectic routine and loads of administrative work may lead to burnout. Viewing these things, it is imperative to improve revenues and provide the best care to patients simultaneously. So, reaching out to experts in orthopaedic medical billing helps medical practices improve health outcomes and increase profitability.


Tim Williamson, a psychology graduate from the University of Hertfordshire, has a keen interest in the fields of mental health, wellness, and lifestyle.

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