Orthopedic medical billing is a crucial aspect of managing a successful healthcare practice, but it can be quite challenging due to its complexity and ever-changing regulations. To ensure smooth revenue cycles, maximize reimbursements, and reduce claim denials, it is essential to optimize your orthopedic billing procedures.
In this comprehensive blog post, we will delve deeper insight into the top seven strategies that can help your practice achieve financial success.
Top ways to improve Practice Orthopedic Medical Billing
Getting correct reimbursement needs accurate medical billing and coding of the treatment provided by the clinicians. Practice revenue will fall if not carefully handled the billing concerns and procedures coding. Additionally, clinicians/practices must ensure to stay abreast of the latest coding and billing protocols that are continuously evolving. Below are some of the tips that you should follow to improve the Practice’s Orthopedic billing and rescue your bottom line.
Verify Insurance Information for Seamless Billing
Accurate patient insurance information is the foundation of efficient billing. Inaccurate or outdated insurance data can lead to claim denials, delayed payments, and frustrated patients. Implement a thorough insurance verification process that includes checking coverage, eligibility, co-pays, deductibles, and any pre-authorization requirements. Regularly update and verify insurance details during every patient visit to ensure a smooth billing process.
Embrace EHR and Specialized Billing Software
Electronic Health Record (EHR) systems and specialized medical billing software can significantly streamline your orthopedic medical billing. EHRs offer seamless integration between patient records and billing data, reducing manual errors and improving overall efficiency. Choose orthopedic-specific billing software that accommodates various procedures and coding requirements, ensuring accurate billing and coding compliance.
Educate Your Billing Team for Precision
Your billing team is the backbone of your orthopedic medical billing process. Ensure that they receive regular training and education on the latest industry regulations, coding changes, and insurance policies. Certified coders with expertise in orthopedics can make a significant difference in the accuracy of your billing. Foster a culture of continuous learning, teamwork, and open communication to create a cohesive billing department focused on achieving optimal revenue results.
Code Accurately and Efficiently
Accurate medical coding is critical for successful billing and timely reimbursements. Orthopedic procedures often have specific coding guidelines that must be followed closely. Hiring certified coders with expertise in orthopedics is a wise investment to ensure precision and compliance with coding standards. Conduct regular coding audits to catch any errors and provide feedback to the coding team for continuous improvement.
Monitor Key Performance Indicators (KPIs)
To optimize your orthopedic billing performance, regularly track and analyze essential Key Performance Indicators (KPIs). These metrics include the average time for claim processing, the percentage of claim denials, the average time to receive reimbursements, and the overall revenue cycle. Analyzing KPIs will help you identify bottlenecks and inefficiencies, allowing your practice to implement targeted improvements and enhance overall billing performance.
Streamline Prior Authorization Processes
Prior authorizations are often required for many orthopedic procedures. Delays or denials in obtaining prior authorizations can lead to delayed reimbursements and unhappy patients. Streamline your prior authorization process by establishing clear communication channels with insurance companies, submitting comprehensive documentation, and utilizing technology to track authorization progress. This will result in quicker reimbursements and a smoother billing process.
Consider Outsourcing for Expert Assistance
Managing orthopedic medical billing in-house can be overwhelming and resource-intensive. If your practice is facing challenges in handling billing processes effectively, consider outsourcing to a reputable medical billing service specializing in orthopedics. Professional billing services have experienced staff who are well-versed in the complexities of orthopedic billing, leading to improved efficiency, reduced claim denials, and better revenue flow.
Common CPT, ICD Codes Used in Orthopedic Billing
In orthopedic medical billing, specific Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes are used to accurately represent the procedures performed and diagnoses made during patient visits. Below are some common CPT and ICD codes frequently used in orthopedic billing:
Common CPT Codes for Orthopedic Procedures:
| # | CPT | Procedures | ||||
| a. | 29824 | Arthroscopic subacromial decompression | ||||
| b. | 29827 | Arthroscopic distal clavicle excision | ||||
| c. | 29881 | Knee arthroscopy, with meniscectomy (medial or lateral) | ||||
| d. | 29888 | Knee arthroscopy, with chondroplasty | ||||
| e. | 23412 | Repair of complete shoulder rotator cuff tear | ||||
| f. | 23430 | Repair of acromioclavicular separation (Rockwood type III, IV, V, or VI) | ||||
| g. | 27244 | Total hip arthroplasty (THA) | ||||
| h. | 27447 | Total knee arthroplasty (TKA) | ||||
| i. | 22551 | Anterior cervical discectomy and fusion (ACDF) | ||||
| j. | 22845 | Posterior lumbar interbody fusion (PLIF) | ||||
| k. | 63047 | Laminectomy with decompression of spinal cord and/or nerve root(s) | ||||
Common ICD-10 Codes for Orthopedic Diagnoses:
| # | ICD-10 | Diagnoses |
| a. | M17.11 | Unilateral primary osteoarthritis, right knee |
| b. | M17.12 | Unilateral primary osteoarthritis left knee |
| c. | M19.011 | Primary osteoarthritis, right shoulder |
| d. | M19.012 | Primary osteoarthritis, left shoulder |
| e. | S42.001A | Unspecified fracture of right clavicle, initial encounter for closed fracture |
| f. | S42.002A | Unspecified fracture of left clavicle, initial encounter for closed fracture |
| g. | S52.501A | Fracture of the shaft of the radius, right arm, initial encounter for closed fracture |
| h. | S52.502A | Fracture of the shaft of the radius, left arm, initial encounter for closed fracture |
| i. | S72.001A | Unspecified fracture of the femur, right leg, initial encounter for closed fracture |
| j. | S72.002A | Unspecified fracture of the femur, left leg, initial encounter for closed fracture |
| k. | M54.5 | Low back pain |
| l. | M25.511 | Pain in the right shoulder |
| m. | M25.512 | Pain in the left shoulder |
| n. | M25.561 | Pain in the right knee |
| o. | M25.562 | Pain in the left knee |
What Makes NEO MD the Best Orthopedic Billing Services Company?
NEO MD stayed best among competitors in terms of providing good Revenue Cycle Management services to practices due to the following cores;
-
- Our experts work hard to reduce your front-end denials by 30%
- First-level claim Acceptance Rate 97.5%
- Offer Provider & Staff Productivity Analysis
- Out of Network Negotiations.
- Provide fortnightly financial and practice overviews
- Identify potential under, over, and incorrect coding scenarios
- Refunds adjustment and Payment posting to improve the cash flow.
- Regular updates on coding compliance
- Use the latest technology and tools to ensure the accuracy of claims and faster collection.
- Offer Services that are easily scalable at all times
- Offer internal Medical Billing audits to uncover loopholes
- Improve RCM system efficiency with a robust credentialing team.
NEO MD’s orthopedic billing services are frequently rated as the finest in the US compared to other revenue cycle management companies. Moreover, NEO MD offers Medical Billing services for small practices, medium, and large offices. Additionally, we provide practices in all US states with specialized billing services. Therefore, the healthcare facilities might locate the top Medical Billing company near me to acquire our services.
Conclusion:
Effectively optimizing your orthopedic medical billing is essential for maintaining a financially successful practice. By implementing the above strategies, including accurate insurance verification, embracing EHR and specialized billing software, educating your billing team, precise coding, monitoring KPIs, streamlining prior authorization, and considering outsourcing when needed, your practice will experience streamlined revenue cycles, maximize reimbursements, and reduce claim denials. Remember that continuous improvement and staying up-to-date with industry changes are key to long-term success in orthopedic billing.
