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What to Know About Orthopedic Medical Billing

April 18, 2023

Orthopedics is a branch of medicine concerned with musculoskeletal conditions like bones, joints, ligaments, and tendons. Billing for orthopedic services involves complicated processes, rules, and resolutions. Therefore, it’s essential to understand the nuances of orthopedic medical billing to avoid costly mistakes that affect your bottom line.

Eliminating orthopedic billing and coding errors creates a healthy revenue cycle, allowing your orthopedic practice to focus more on patient care and scale faster. 

What Services Are Included in Orthopedic Medical Billing?

Orthopedic medical billing documents all services performed throughout a patient’s visit. It’s important to ensure these aspects of the orthopedic billing process are performed correctly for maximum reimbursement:

  • Verification of patient’s insurance eligibility
  • Entry of patient demographics
  • Documentation and coding of services and procedures performed
  • Timely claims submission
  • Reprocessing denied claims

What Are Some Common Mistakes Made in Orthopedic Medical Billing?

Failure to Verify Insurance

Initially, your patient’s insurance eligibility should be verified, reducing financial risks and leading to smoother claim processing and higher reimbursements. Many orthopedic practices fail to verify a patient’s coverage, resulting in denied claims and hefty patient bills. 

Incorrect Entry of Demographics

Each piece of patient demographic data must be entered correctly during the orthopedic billing process. Even the slightest error, such as an incorrect date of birth or misspelling, can lead to an automatic denial from insurance companies.

Incorrect Documentation

One of the most important parts of orthopedic billing is correct documentation of each service or procedure performed. Incomplete notes, missing reports, and inaccurate coding lead to denied claims. 

coronis health orthopedist examining patient

Orthopedic medical billing, in particular, has a nuanced system of codes and regulations. Correct ICD, CPT, and modifier codes must be used to ensure maximum reimbursement. 

Examples of common orthopedic coding errors include:

  • Unbundling. This involves coding the parts of a procedure individually when a single code should be used. For example, the three parts of the knee (medial, lateral, and suprapatellar) have a unique code, and all procedures performed in that area of the knee must be bundled in that code.
  • Fracture care. Prefabricated casts or braces are often given Q codes for casting and strapping. However, Q codes should be reserved for custom-made casts or braces only, while prefabricated casts should use an L code.

In addition to the nuances of coding for orthopedic procedures, changes frequently occur in orthopedic billing guidelines, making it difficult for staff to stay up to date.

Long Claims Submission Process

A common challenge for orthopedic billing is submitting claims quickly. Timely and accurate submissions reduce the risk of denials and eliminate the need to reprocess claims. Denied claims can drag out the process and prolong revenue from reimbursement. After too long, the claim may slip through the cracks altogether, resulting in lost revenue.

How Can They Be Avoided?

Some of our tips for avoiding denials include:

  • Being diligent about verifying insurance coverage 
  • Ensuring patient information is correct when collected and entered
  • Staying on top of changes to orthopedic billing and coding guidelines
  • Submitting claims promptly
  • Following up with denied claims

Avoiding billing mistakes is crucial to the health and longevity of your orthopedic practice. A knowledgeable team on the dos and don’ts of orthopedic medical billing is key to keeping revenue flowing in your practice and scaling faster.

The Importance of Ensuring Compliance With Coding and Regulations

coronis health orthopedist examining a patient's fingers and joints

All information in claim documents is thoroughly scrutinized to ensure you meet the regulations set forth by HIPPA, CMS, AMA, and insurance companies. Therefore, it’s important to verify all relevant requirements and guidelines are met before claims are submitted.

If your claims don’t comply with regulations, it could result in costly fines or penalties for your practice. Compliant coding leads to faster processing and fewer denials—making it a vital component of a healthy revenue cycle.

The Benefits of Outsourcing to an Orthopedic Billing Expert

Orthopedic medical billing can be challenging for your staff if they aren’t experts in its complexities. Denied claims lead to frustration and financial stress for your practice. Our orthopedic billing consultants at Coronis Heath understand your staff’s unique challenges and can handle all of your billing and coding.

Some of the benefits of outsourcing to the orthopedic billing experts at Coronis are:

  • Lower denial rate
  • Increased reimbursement rate
  • Quick claim submissions
  • Compliance with changing regulations
  • A streamlined revenue cycle
  • Financial KPI reports
  • More time for your staff to focus on patient care

Coronis Health offers comprehensive orthopedic billing services to relieve your team’s stress and help your practice run smoothly. Contact us today to learn how our orthopedic billing services can help optimize your revenue cycle and request a free financial checkup.

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