06 Jan Overview of Medical Billing for Orthopedic Practices
Orthopedics is a medical specialty that involves musculoskeletal system treatment. This include treatment of bones, ligaments, joints, tendons, and muscles. Around 35% of all orthopedic surgery claims are not processed correctly by insurance payors.
In addition, more than 25% of all medical claims are rejected, with 15% never resubmitted. Find out how outsourcing your medical billing will improve reimbursement.
What is involved in Orthopedic Medical Billing?
Orthopedic billing covers a wide scope of services and procedures compared to most medical specialties. Payor-specific guidelines and rules can leave the practice underpaid. Orthopedic medical billing involves understanding arcane and complex billing codes.
What do Orthopedic Medical Billers Do?
Medical orthopedic billers understand the specialization of orthopedic practice billing. These professionals can:
- Assign accurate and correct codes to multiple procedures
- Provide both paper and electronic billing
- Analyze accounts to prevent blocking cash flow
- Perform regular code audit checks to apply appropriate codes
- Follow-up with payors regarding pending payouts
- Generate daily, weekly, and monthly financial statements
How can Orthopedic Coding be Effective and Streamlined?
Orthopedic practice perform numerous clinical activities each day, such as joint repair (arthroplasty), surgeries, occupational therapy, chiropractic, physiotherapy, musculoskeletal oncology, and sports medicine. Orthopedic coding for services requires medical billers who can code effectively and streamline the billing process.
What Qualifications do Orthopedic Medical Billing Professionals Have?
Medical billing specialists should have certain qualifications. These include:
- Certification from the American Association of Professional Coders (AAPC).
- Training with billing software, such as Medisoft, Lytec, Medic, Misys, and NextGen.
- Training with coding software, such as Flashcode, CodeLink, and EncoderPro.
- Ability to successfully negotiate payment with Medicare and Medicaid payors.
- Ability to apply standard CPT procedure codes, HCPCS supply codes, and ICD-10 diagnosis codes.
How can I Improve my Revenue Management Cycle?
The medical billing process involves patient enrollment, scheduling, insurance verification, insurance authorizations, scheduling, coding, billing, and reconciling accounts. To improve the revenue management cycle, the orthopedic billing process should embrace simplicity in submission and retrieval of documents, real-time report generation, pre-audits on coding, and application of suitable modifiers.
Should I Outsource my Medical Billing?
Orthopedic practices often outsource their medical billing, which is a popular method for addressing a remarkable loss of income. This billing option can lead to orthopedic billing success, especially when the medical billing company has knowledgeable, competent workers who understand the complex rules used by insurance companies to regulate orthopedic medical claims.
Orthopedic practices often face increasing costs to ensure money is not left behind in lost revenue. Using properly trained orthopedic billers will allow the facility to collect all of the money due to the practice through appealing denied claims and answering technical, specific questions about diagnoses and procedures.
In addition, appropriate medical billing for an orthopedic practice requires the ability to track underpayments. This can be complicated due to the rules of multiple procedures. When properly done, this can increase orthopedic collections by 7-10 percent.
Is Medical Billing more complicated in Orthopedics?
Both medical and patient billing is more difficult for everyone. The patients who have high balances and complicated explanations from payors do not always understand the invoices received from the practice. An orthopedic billing specialist must have the ability to discuss these issues with the patients for improved collections.
MPMR offers top orthopedic medical billing services to clients nationwide. The firm believes not only in increasing practice revenues, but also operational efficiencies. Call today for a complimentary consultation and see what MPMR can do for your orthopedic practice!