Our Services
Orthopedics Medical Billing Services
Orthopedic practices face unique billing challenges due to the complexity of musculoskeletal procedures, surgical modifiers, and payer-specific requirements. At Practice Claim, we provide specialized Orthopedics Medical Billing Services designed to maximize reimbursements and reduce denials. Whether you run a private orthopedic practice, group clinic, or hospital-based surgery center, our team ensures accurate coding, efficient claim submission, and full compliance with regulations.
Why Orthopedic Billing Requires Expertise?
Orthopedic billing is a highly complex process that involves detailed documentation, bundled services, and the frequent use of modifiers. Errors can quickly result in claim denials or underpayments. Some of the challenges include:
- Correct coding for fracture care vs. surgical repair
- Applying global period rules to bundled orthopedic surgeries
- Managing multiple procedures performed in a single session
- Ensuring compliance with payer-specific authorization requirements
Our orthopedic billing experts at Practice Claim understand these nuances and ensure clean claims that get paid faster.
Components of Orthopedics Medical Billing
1. Patient Eligibility Verification & Authorizations
Before services are provided, our team confirms patient demographics, insurance coverage, co-pays, deductibles, and pre-authorization requirements. This prevents billing surprises and ensures a smooth reimbursement process.
2. Specialized Coding and Documentation
Orthopedics involves a wide range of procedures. Below are some of the most frequently used CPT codes:
- Fracture Care: 25605 (radius fracture), 27506 (femur fracture)
- Joint Replacement: 27130 (hip replacement), 27447 (knee replacement)
- Arthroscopy: 29881 (knee), 29880 (shoulder)
- Spinal Procedures: 63047 (laminectomy), 22612 (spinal fusion)
Casting and Splinting: 29075 (short arm cast), 29125 (forearm splint)
3. Streamlined Claims Submission and Tracking
Claims are submitted electronically with payer-specific requirements built in. We monitor each claim until payment is received, resolving rejections or errors quickly to speed up reimbursement.
4. Transparent Patient Billing and Payment Posting
Our billing specialists handle patient statements with clear, professional formatting. Payments are posted accurately, reducing confusion and improving patient satisfaction.
5. Denial Management and Appeals
Orthopedics practices often face denials related to session length, lack of documentation, or authorization errors. We analyze each denial, appeal with supporting records, and recover revenue that might otherwise be lost.
Challenges in Orthopedic Health Billing
Frequent Coding Updates
Orthopedic billing requires constant attention to CPT and ICD-10 updates. Codes for psychotherapy, behavioral therapy, and telehealth often change, making it critical for practices to stay current to avoid claim rejections.
Insurance Coverage Variability
Unlike other specialties, Orthopedic benefits differ significantly across insurance providers. Limitations on sessions, coverage exclusions, and parity law compliance make billing highly complex without expert guidance.
Authorization and Documentation Requirements
Orthopedic services often require prior authorization and detailed session documentation. Missing notes or incorrect authorization can result in claim denials and payment delays, directly impacting practice revenue.
Advantages of Outsourcing Orthopedic Health Billing
Outsourcing your Orthopedic health billing to our specialized service can provide numerous benefits, including:
Expert Handling of Complex Procedures
Our coders are very well versed with detailed cardiovascular procedures as well as the codes to be billed and hence any billing errors are almost eliminated.
Faster Reimbursement
Our claim submission is integrated and we also effectively handle denials, thus enhancing timely cash receipts.
Reduced Administrative Burden
Our extensive billing services save your in-house team time to attend to the patients only by providing minimal interference work and pressures.
Cost Efficiency
The decision to outsource can be beneficial because outsourcing is cheaper than having an independent billing department for small practices.
Data Analytics and Reporting
We offer comprehensive billing reports and analysis that can show you your business revenue status and areas of compliance concern.
Comprehensive Orthopedic Billing Services We Provide
At Practice Claim, our Orthopedic Billing Services cover every aspect of your revenue cycle:
Accurate CPT and ICD-10 Coding
for fracture care, joint replacements, spinal procedures, and arthroscopies
Modifier Management
to ensure compliance for bilateral, multiple, and post-operative services
Claims Submission and Tracking
with payer follow-up to minimize delays
Denial Management and Appeals
to recover lost revenue from underpaid claims
Authorization Assistance
for complex orthopedic surgeries
Benefits of Outsourcing Orthopedic Billing to Practice Claim
Certified Coders
Our certified team is always updated on the latest in mental health coding.
Compliance Assurance
We strictly follow the best practices in the industry and ensure our processes are in compliance with the most recent standards.
Advanced Revenue Cycle Management
We take full charge of billing from submission of claims, through Claims Management to posting of payments to enhance revenue.
Customized Solutions
Our services suit the needs of the individual practice, a group practice or a multispecialty center.
Proven Track Record
Orthopedics billing services have been successfully provided by us to practices all over the country, backed by similar improvements in collections and denials.
Frequently Asked Questions
Fracture care, joint replacement, arthroscopy, spinal surgeries, and casting are the most common services billed. Codes include CPT 25605, 27130, 27447, 29881, 63047, and 22612.
Modifiers such as 50 (bilateral procedure), 51 (multiple procedures), 59 (distinct service), and 78 (return to OR) are crucial for accurate payment.
The most common reasons include improper use of global surgical packages, incorrect CPT coding, missing prior authorizations, and incomplete operative documentation.
The global package includes pre-operative visits, the surgery itself, and post-operative care. Billing separately for bundled services without modifiers often leads to denials.
Outsourcing reduces errors, speeds up reimbursements, ensures compliance, and allows orthopedic providers to focus on patient care rather than paperwork.
