Coronis Health, Primary & Specialty Physician
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 billing covers a wide scope of 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, confirming accurate payment and billing patients are also processes followed by the Orthopedic billers.
Outline of the Orthopedic Billing Process
Completed through EHR/EMR
- E/M coding:
- Report based on components of history, exam, and medical decision making.
- In-office procedures:
- New Injury/problem; exacerbation of a previous injury/problem; unanticipated change in the condition; change in treatment plan.
- 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 claim is billed electronically
- 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, be proactive in verifying benefits and coverage, including if prior authorization is required. For Medicare, if the services are not covered the patient needs to sign an Advanced Beneficiary Notice (ABN).
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 result in missed opportunities for reimbursement. 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 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 orthopedic medical billing specialists. Just like with other specialties, billing codes for orthopedic procedures 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 billing codes depending on the actual procedure.
For orthopedic procedures, the billing varies based upon what type of procedure is being performed. In general, orthopedics deals with issues with the bones, tendons, ligaments, and/or muscles. The coding can differ depending on which portion of orthopedics under which the procedure falls.
Tendon & Ligament Procedures
Different still are the procedures of the tendons and ligaments. Repair procedures for those parts would begin “0L” and “0M,” respectively. This includes:
- The code for a tendon repair in the right lower arm could be coded as one of the following: 0LQ50ZZ, 0LQ53ZZ, or 0LQ54ZZ, depending on the approach being used.
- The code for a ligament repair to the right lower arm could be coded as one of the following: 0MQ50ZZ, 0MQ53ZZ, or 0MQ54ZZ.
For procedures, the character structure is as follows:
- The first character designates the section in which the procedure falls in the ICD-10.
- The second character denotes the body system that is being affected by the procedure.
- The third character is determined by the root operation (main objective) of the procedure.
- The fourth character is established as the character that specifies which body part is being affected by the procedure.
- The fifth character defines the approach of the procedure.
- The sixth character outlines the device being used.
- 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. For many practices, 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 a claim and then write it off. This has a huge impact on a practice’s cash flow and revenue. Practices are hemorrhaging money as a result of poor AR follow up, making it critical to have a clear process in place for follow up. Read more about preventable 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
Contact Coronis Health today to learn more about how we can increase revenue and lower administrative costs for your orthopedic surgery practice.