Coronis Health, Primary & Specialty Physician

Orthopedic Surgery

Coronis Health knows that orthopedic billing and revenue cycle presents a unique set of challenges. Many internal and external billing teams struggle with every piece of the billing process. Coronis Health has decades of experience, offering you the best of the best in medical billing. If your practice is struggling with orthopedic billing, Coronis is here to help.

Overview of Orthopedic Billing



Orthopedic medical billing covers a wide scope of provided services and procedures. Orthopedic medical billers are required to know coding, understand the billing process, and know the payor specific guidelines. In order to be proactive and receive revenue without delay, the Orthopedic biller/coder is responsible to code the procedures and diagnosis codes and works closely with the providers to educate and to obtain specific answers in order to code correctly. Submitting claims, posting payments, following up on rejections or denials, understanding medical billing software, confirming accurate payment and billing patients are also processes followed by the orthopedic billers. Staying on top of these processes can be challenging for any in-house billing specialist.

As a medical billing company with more than 30 years of experience, Coronis Health is well versed in the medical billing process. Our certified coders and professional orthopedic billing experts understand the complexities and nuances involved in the world of medical coding and billing.

While our successful track record speaks for itself, we welcome the opportunity to go above and beyond for your facility by reducing your claim denials, diversifying your revenue opportunities, and increasing your cash flow. We offer comprehensive orthopedic medical billing services and streamlined processes to help reduce the amount of money and time spent on administrative work, so you can focus on providing exceptional patient care.

For a free financial health checkup, contact the orthopedic billing team at Coronis Health today.

Outline of the Orthopedic Billing Process

To deliver the best orthopedic billing services possible, we’ve provided a thorough overview of how the process works. Whether you’re processing orthopedic surgery claims or billing for an orthopedic trauma treatment, Coronis Health has the billing and coding services your facility needs to increase revenue.

Office charges:

Completed through EHR/EMR

  • E/M coding:
    • Report based on components of history, exam, and medical decision making.
  • In-office procedures:
    • Injections
    • X-rays
  • Documentation:
    • New Injury/problem; exacerbation of a previous injury/problem; unanticipated change in the condition; change in treatment plan.

Surgery:

  • Operative Report is sent electronically through Ebridge.
  • Coder codes the OP Report with procedure codes and Diagnosis Codes
  • The OP report with the procedure codes and the DX Codes is then loaded to ebridge for the Charge entry team to enter.

After charge posting:

  • The medical claim is submitted electronically through advanced medical billing software
  • Rejections are worked on a daily basis through the Charge entry team.
  • Payments are posted and any ansi/reason codes are posted
  • If denied, the AR team will work on the denials
  • If Paid, confirm payment is correct
  • Any co-pay, co-ins or deductible is sent to the patient via statements, emailed statements or hard copy statements.

Eligibility and Verification

There are many medical reimbursement policies, so be proactive in determining insurance verification and coverage, including if prior insurance authorizations are required. For Medicare, if the services are not covered the patient needs to sign an Advanced Beneficiary Notice (ABN). Meanwhile, many leading commercial carriers, such as United Health and the Blue Cross Group, have their own reimbursement policies that can make processing medical bills difficult. That’s why it’s important for medical billing companies to take the time needed to negotiate successfully with commercial carriers should they need to.

Coding

Similar to other specialties, orthopedic coding has its challenges. Coding denials can be common in orthopedics and often are a result of poor documentation. Best practice is to code based on documentation, not reimbursement, which can cause issues when doctors are not documenting thoroughly. Many providers fail to document key pieces of information, which can interfere with the orthopedic billing process and result in missed revenue opportunities. Medical coding guidelines are constantly changing, as are payor guidelines, and many doctors and internal teams struggle to keep up. Holding regular education sessions for not only professional coders and billers, but also for providers, is crucial. You can read more about common orthopedic coding errors here.

Coronis Health can make sure your practice is ready for ICD-10 with certified coders and professional orthopedic medical billing experts. Our certified coders work with advanced coding software and perform regular audit checks to reduce denials and improve your revenue cycle management. Understanding how to apply standard CPT, ICD-CM diagnosis coding, and supply codes that follow CMS guidelines is essential when providing expert coding services.

Just like with other specialties, medical billing codes for orthopedic services differ according to criteria set in the ICD-10-PCS. Using these specific codes, medical billing specialists can bill the proper procedures to a patient’s insurance company, creating a more unified system of billing and coding.

There are many different types of medical specialties that require specific coding for billing and even within certain specialties, there can be different medical billing codes depending on the actual procedure.

For orthopedic procedures, medical billing services vary based upon what type of procedure is being performed. In general, orthopedics deals with issues with the musculoskeletal system, which includes the bones, tendons, ligaments, and/or muscles. The coding can differ depending on which portion of orthopedics under which the procedure falls. For example, medical billing for custom orthotics in pediatric orthopedics will require different coding services than for an orthopedic practice performing multiple procedures for adults.

Tendon & Ligament Procedures

Different still are the procedures of the tendons and ligaments, such as a PLC reconstruction. Repair procedures for those parts, which typically requires submitting orthopedic surgery claims, would begin “0L” and “0M,” respectively. This includes:

Character Designation

For procedures, the character structure is as follows:

  1. The first character designates the section in which the procedure falls in the ICD-10.
  2. The second character denotes the body system that is being affected by the procedure.
  3. The third character is determined by the root operation (main objective) of the procedure.
  4. The fourth character is established as the character that specifies which body part is being affected by the procedure.
  5. The fifth character defines the approach of the procedure.
  6. The sixth character outlines the device being used.
  7. The seventh character provides any other qualifying information pertinent to the procedure in order to make the coding process as simple as possible.

Accounts Receivables and Denials

With growing deductibles and reduced timely filing timelines, orthopedic practices are getting hit from many angles, and it’s taking a huge toll on their accounts receivables (AR). For many orthopedic physicians, they do not have the bandwidth to stay on top or AR and fight to win claims. It is not uncommon to see one or two attempts to resolve medical claim denials and then write them off. This has a huge impact on a practice’s cash flow and revenue cycle. Practices are hemorrhaging money as a result of poor AR follow up, which disrupts the revenue cycle, making it critical to have a clear process in place for follow up.

Coronis Health stands out in the medical billing industry by providing comprehensive orthopedic billing services, such as audit checks, regular reports, and account analysis. Read more about how to prevent problems caused by orthopedic denials here.

Best Practices for Patient Collections

Patient is contacted by email prior to their follow up appointment to inform they have a balance; this should be collected in the office.

  • 2 statements sent to patient
  • Email as a final attempt
  • Balance over 1,000.00 a call is placed as a final attempt
  • Send client for approval.
  • Approved accounts are forwarded to the collection agency.

Learn More About How Coronis Can Improve Your Revenue

Not all medical billing companies are the same. With a broad range of billing and coding services, Coronis Health is committed to providing first-rate orthopedic billing services for your facility. Contact Coronis Health today to learn more about how our leading medical billing company can improve your revenue cycle and lower administrative costs for your orthopedic surgery practice.