Effective Orthopedic Billing Solutions for Optimal Results
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
Overview of
Orthopedic
Medical Billing Services
Medical billing for orthopedics is more complex than other specialties. It requires precise and adequate documentation before, during, and after the patient encounter. The billing and coding team must collaborate with the clinical staff to ensure properly documented charges for high reimbursements and timely payment collections.
Luckily, we have a team of billing specialists and certified professional coders (CPCs) experienced in the intricacies of orthopedic procedure requirements and guidelines. Our team ensures accurate code assignment, proper T-code selection, the appropriate usage of modifiers, and complete documentation to avoid denials. Our team's knowledge spans across but is not limited to orthopedic billing services for the following procedures:
ACL
Reconstruction
Foot &
Ankle Surgery
General
Orthopaedics
Hand
Surgery
Hip and
Knee Surgery
Orthopedic
Oncology
Osseointegration
Clinic
Shoulder and
Elbow Surgery
Spine
Surgery
Trauma
Surgery
Common Challenges in Orthopedic Billing
and Coding
Managing orthopedic billing and coding workflow on your own may seem like a cost-effective idea to avoid giving your hard-earned money to a third-party medical billing company. However, it is time to bust this myth!
Orthopedic medical billing is a complex procedure. It requires you to thoroughly review the provider's notes and choose the accurate codes from hundreds of orthopedic code sets. Besides, the requirements to comply with bundled and unbundled services and providing modifiers for additional clarity can make things more burdensome to manage single-handedly.
Incomplete Documentation
Accurate and completeness of documentation is essential to establish medical necessity and the appropriateness of performed orthopedic procedures. However, missing or inadequate information can lead to a higher denial rate.
Lack of Prior Authorization
Another orthopedic billing challenge is not obtaining pre-authorization for specific services from the insurance payer. Lack of authorization may lead to claim denials or underpayments, negatively impacting the revenue cycle.
Incorrect Code or Modifier
Hundreds of codes and modifiers are available to report specific orthopedic procedures and provide details. However, these many codes often create confusion, leading to errors like undercoding and upcoding.
Different Payer Requirements
The next major challenge you may face while handling orthopedic billing and coding in-house is the varying payer requirements for different insurance companies. This adds to the complexity.
Why Choose MediBill MD for Orthopedic Billing Services?
Are you thinking of partnering with an orthopedic billing company to help you overcome all the orthopedic billing challenges dragging your practice down? Now, that’s a SMART idea!
MediBill MD is here to serve you! We have an experienced team of orthopedic billing specialists and coders who keep their certifications updated and stay informed on the evolving industry standards to handle your billing and coding workflow for a higher claim first-pass rate, reduced denial rate, and limited A/R days. Still not sure why should you hire us? Check out the benefits you can get below!
When you outsource orthopedic billing and coding, you don't have to invest in costly infrastructure, systems, software, and hiring staff. You only pay a small percentage against your monthly payment collections, offering a cost-effective alternative.
Our orthopedic billing specialists understand the specificity related to orthopedic procedures. As a result, our team makes fewer errors and helps you identify billing challenges related to underpayments or denials for a seamless revenue cycle.
Hiring, training, and retaining orthopedic medical billing specialists and certified coders is challenging. However, you can easily scale up or down based on your requirements by outsourcing billing and coding to us.
Our experienced coders and billers proactively track each submitted claim to ensure an optimized payment cycle for a steady cash flow. It ultimately reduces the A/R days and streamlines your orthopedic practice's revenue cycle.
Different payers have specific requirements, and the coding system standards also undergo constant updates. Our orthopedic billing team stays current on these changes to ensure compliance, saving you from legal issues and financial penalties.
Whether you are running a solo orthopedic practice in California or providing orthopedic care in a group practice in New York, it hardly matters! MediBill MD takes pride in empowering orthopedics in all 50 states of the USA. Yes, you heard it right! So, regardless of your location, feel free to contact our representatives and get a quote for orthopedic billing services.
Prevent Orthopedic Billing & Coding Errors with MediBill MD
Understanding orthopedic medical billing challenges is only one side of the coin. Wondering what the other side entails? Well, it demands you to effectively navigate the challenges by implementing billing best practices and streamlining the revenue cycle management.
That’s what we at MediBill MD thrive at! Our billing and coding professionals utilize industry best practices to achieve coding accuracy and billing excellence for maximum reimbursements.
| Common Orthopedic Billing & Coding Errors | MediBill MD Solution | |
|---|---|---|
| Incorrect use of the 7th corrector in the ICD-10 code. | Our billing and coding team pays close attention to documentation to reflect the 7th character changes in the follow-up visits. | |
| Overuse of laterality modifiers. | We put effort and time into understanding the CPT code definitions to avoid overusing the laterality modifiers that lead to reimbursement challenges. | |
| Failure to report T-code from chapter 19 in the ICD-10 coding manual. | Our team takes extra care while assigning the T-codes to accurately reflect the complications when reporting initial patient encounters. | |
| Pre-assigning diagnosis codes for suspected illnesses. | Our team carefully reviews the documentation to identify symptoms and signs to assign accurate codes for diagnosing orthopedic conditions. | |
| Inattention to parenthetical notes may lead to denials for bundled procedures. | We understand the need to review parenthetical notes that state the specific requirements for reporting the codes and generate claims accordingly. | |
Affordability is a top consideration when it comes to outsourcing. MediBill MD excels in this aspect as well! We offer you tailored orthopedic medical billing services at unbeatable prices.
Price Comparison Calculator
Based on your annual collections, we will calculate the in-house medical billing cost and compare it with the MediBill MD service charges.
Get In Touch with an
Orthopedic Billing Specialist
Struggling in the competitive healthcare landscape? It is time for your orthopedic practice to not only survive but thrive. Contact us to hire a dedicated orthopedic billing specialist.
FAQs
MediBill MD is a leading billing company empowering orthopedic surgeons throughout the US by offloading their shoulders from intricate medical billing procedures. We have a track record of helping orthopedic practices realize financial success, and our client testimonials are proof of it.
Yes, MediBill MD stays current and complies with the latest orthopedic medical billing and coding regulations to ensure maximum reimbursements and prevent legal issues and financial penalties.
The cost of outsourcing orthopedic billing services to MediBill MD depends on several factors, including the size of your practice. Thus, we recommend you schedule a call with us to get your pricing queries answered.
MediBill MD has a team of certified professional coders (CPCs) and billing specialists well-versed in the specific requirements of orthopedic billing and coding to help you achieve financial success and peace of mind.
Orthopedic medical billing is the process that ensures a healthier revenue cycle, steady cash flow, and streamlined operations for the orthopedic practice through timely reimbursements for the rendered care services.
Orthopedic billing is challenging because it involves many treatments and procedures, such as fracture care, arthroscopic surgeries, joint replacements, etc. Each procedure has specific billing requirements and codes, making the appropriate code selection and accurate documentation a taxing task.
Orthopedic Current Procedural Terminology (CPT) codes are specific codes that medical billers use to report the procedures performed by orthopedic surgeons. Here are some CPT code ranges for orthopedic surgeries and services.
- 20100-20999 - General Surgical Procedures on the Musculoskeletal System
- 22010-22899 - Surgical Procedures on the Spine (Vertebral Column)
- 23000-23929 - Surgical Procedures on the Shoulder
- 25000-25999 - Surgical Procedures on the Forearm and Wrist
- 27600-27899 - Surgical Procedures on the Leg (Tibia and Fibula) and Ankle Joint
- 29000-29799 - Application of Casts and Strapping
Orthopedic billing is an intricate process, and there isn’t any single CPT code to cover all types of consultations. However, the CPT codes 99242-99245 are used depending on the complexity and patient history for the outpatient consultation. Contrarily, the CPT codes 99252-99255 are reported depending on the complexity of inpatient consultations.
Upcodingrefers to the incorrect coding providers do to receive higher reimbursements for simple procedures. It occurs when healthcare providers mix up codes in medical claims to refer to more severe procedures or diagnoses than provided.
You may use codes 99231-99233 for initial inpatient visits, while codes 99221-99223 for subsequent inpatient visits or observation care. Similarly, you may report codes 99211-99215 for outpatient visits of established patients, while codes 99201-99205 for new patients outpatient visits.
Downcoding is the complete opposite of upcoding. It occurs when doctors mistakenly use incorrect codes to refer to less severe procedures or services than provided. As a result, healthcare providers receive lower reimbursements.
ICD-10 codes are used for diagnosis purposes and not to specify care type. Besides, there are different codes to report various orthopedic care categories. For example, M00-M99 covers musculoskeletal systems and connective tissue disease, S90-S99 covers injuries to the ankle and foot, etc.
Z47.89 is the code used for orthopedic aftercare.
It is an alphanumeric code that classifies orthopedic surgeons based on professional credentials. 207X00000X is the taxonomy code that signifies orthopedic surgeons for allopathic and osteopathic licensed to diagnose, treat, and prevent musculoskeletal conditions.
