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Orthopedic Billing Services

Orthopedic billing is the most critical aspect of orthopedic medical services. Transparent coding and billing in orthopedic billing can make more claims go through, increase the cash flow, and help your business grow.

Denials often occur when making the orthopedic claims submission, and if the correct initiative is taken on time, one can save the whole ordeal of denials and claims re-submissions. Unfortunately, orthopedic billing demands more time and energy due to the apparent complexity involved in billing and coding processes.

There is a need for proper billing and coding strategies to increase the chance of reimbursement and reduce denials. The following steps can be helpful; however, If you need further clarification, getting orthopedic billing services can be the right choice for your medical practice.

Right Billing Process

Orthopedic medical billing can be a complicated and time-taking process as thE field requires complex coding and documentation to get on-time reimbursements. 

Follow these tips to improve your orthopedic medical billing processes: 

  • Understand each payer’s requirement individually. Each insurance company follows a different coding and documentation process, so follow the coding pattern carefully. 
  • Use relevant codes that best define the medical procedures. When using irrelevant codes, insurance companies do not accept the claims. Furthermore, make sure you are using the most relevant and updated coding manuals. 
  • Save all medical coding details and records; well-managed documentation is essential to getting reimbursement from insurance companies. More , keep information safe for future use. 
  • Submit the claim right after you treat the patient; keeping the claims in the pipeline will lead you toward more waiting for payments.
  • Don’t get demotivated over denials! Resubmit right after correcting the mistakes in the denials.

Prior Authorization

More than 370 healthcare providers consider prior authorization a challenging task as each process undergoes a time-consuming process, with many phone calls and faxes, and later on, they have to resort to appeals. However, artificial intelligence tools can automate the orthopedic EMR/EHR processes with easy manual input.

The process will include the following:

  • Determine if a PA is a requirement or not. In case the answer is yes, prepare the insurance information and patient demographic along with the medical diagnosis
  • Using an electronic portal to submit the PA to the insurance payers
  • Analysis executes follow-up and appeals in real-time.
  • Let the scheduling department know you get your PA approved so one can prepare accordingly. 
  • Use the analytics dashboard to analyze the prior authorization workflow for a transparent process

Denial Management

Another big challenge for orthopedic revenue is managing the denial claims and keeping an eye on the account receivables. According to an estimation, nearly 60 percent of the claims are denied due to write off, whether they need more expertise over the appeals prices or follow-up. 

However, the denials management process can be automated to reduce the denials. 

  • Making predictions, prioritizing the recovery, and forecasting collectible dollars/timeline.
  • Predicting each denial’s next best course of action through predictive analysis
  • Automated appeals letters, status checks on EOBs, and resubmissions by using an integrated system
  • Preventing future revenue leaks by reviewing root causes and solutions
  • Analytics for real-time operations that guarantee efficiency, accuracy, and transparency

Claim Management

First, you need to understand how payer process claims work for orthopedic claims management. 

Each payer has a different claims procedure. However, having a specific road map for each insurer is indispensable. Once you comprehend the submission process, you can find out how to accurately manage your claims. 

  •  Electronic medical billing software is also the best way to manage your medical billing software–This software provides an automated solution for many tasks like claim submission, resubmission, the submission of claim forms, tracking payments, and denial management. 
  • Using software to automate claims management is the best practice and improves the chance of getting reimbursed promptly. Other billing software is also a way to get reimbursement on a timely basis.
  • Alternatively, you can outsource your claims management to a professional medical billing company, which provides you with the best solution for all your practices. 
  • If you are unsatisfied with your practice revenue and want to increase your revenue and reduce the risk of denial, orthopedic medical billing is the perfect solution. 


Managing Account Receivables

Account receivables in orthopedic medical billing can be another challenge. There are many ways to do the billing process. However, if you pick the wrong one, the chances are that you will lose more reimbursements. 

 The following tips can ensure you are following the accurate and latest version of the account receivables:

  • Keep accurate/relevant records, and perform the related diagnosis and treatment codes
  • Beware of any changes in the patient’s insurance information
  • Verify all necessary details when submitting a claim to the insurance company
  • Include all essential information on the documents for each claim
  • If the denial happens, don’t hesitate to resubmit the claim immediately

Final Thoughts

To increase income and decrease claim denials, orthopedic billing services can be a very effective strategy. If you have proper methods, you can improve efficiency, accuracy, and compliance without causing costly errors that could result in lower reimbursements or denials of claims. The suggestions above will ensure that you can take full advantage of the orthopedic billing services available to you and your patients.