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Orthopedic Revenue Cycle Management & Billing Services

Did you know that Orthopedics is one of the popular medical practices and is on the verge of continued growth? As per the American Academy of Orthopedic Surgeons, about 15% of orthopedics have their own private practice, while others are either a part of a large hospital or are combined with other practices in different healthcare organizations.

No matter if you have a private practice or a consolidated orthopedic practitioner, there is always an additional responsibility of handling the administrative burden or backend of your business apart from treating patients. There are practitioners who choose to handle the entire medical billing process internally, while others hire external Orthopedic billing services. It doesn’t matter which mode you choose, but it is certainly essential to know the nuances of the trade.

Are you aware of the fact that many claims get rejected or denied by the payer due to errors made by the billing and coding team? However, the good part is that these errors are preventable, and the revenue cycle management can be brought back to track just by handling them properly.


Relevance of Orthopedic Billing and Coding

One of the most important revenue cycle management functions for any practice, including Orthopedics, is billing and coding. Once proper coding and billing practices are initiated, revenue will continue to grow with minimal delays. This reduces stress and cash flow issues for your orthopedic practice.

Orthopedic billing is an important part of the entire healthcare system because it ensures that physicians are paid on time for the services they offer to their patients. If accurate coding and billing processes don’t take place in healthcare, physicians or surgeons would be unable to receive payment from insurers. As a result, if efforts are not made to get timely payments, many physicians or surgeons may face financial hardship.

In addition to this, timely and accurate orthopedic billing and coding ensures that patients receive adequate care based on their diagnosis code(s). Based on each patient’s individual needs for surgeries, diagnoses, procedures, and so on, Orthopedic surgeons can focus on ensuring that they are imparting the best possible care.

Different challenges arise daily that must be tackled time and again to keep the functioning of the revenue cycle in a proper manner.


Let’s discuss the challenges that arise in Orthopedic practice

Getting prior authorizations

There is a AMA survey which state that it takes about 16 hours every week per healthcare provider to get prior authorizations. When we talk about orthopedic practices, this number can go even up to 30. When prior authorizations are not handled precisely by medical billing companies, the patients may suffer and have to wait anywhere from one to five days without getting the right treatment.

In this scenario, various patients give up on such practices where they are regularly made to wait long periods of time just for prior authorizations. As a healthcare provider, it is your duty to check your prior authorization process regularly and then find out how effectively it is handled.

There are various options available in the industry that are ready to handle your administrative burden. However, it is necessary that you choose the one that suits your Orthopedic billing requirements. Eminence RCM is one such orthopedic medical billing service provider that can handle your entire prior authorization process smoothly.

Challenges in Coding Process

Medical coding poses challenges in every healthcare sector and Orthopedic is no exception. This is because ICD codes keep updating on a regular basis. The current version that is in use in the USA is ICD-10-CM.

Apart from that did you know that ICD-11, which is the eleventh version of code updates, has already been released? The ICD-11 version came out in January 2022 and the expected implementation year for the same could be 2025 for all the healthcare practitioners, medical billing and coding companies.

This poses a new challenge for all the orthopedic coders and billers to unlearn and relearn again in the near future. It is necessary that your coding and billing team has already started the process, or you will be left behind.

In the current ICD-10 list, coders have to be careful about using the right modifiers and codes to save the practice of getting overcharged or undercharged by the payers. The tiniest error can take you toward claim denials and rejections. This means you won’t get paid as a healthcare provider.

Getting used to inefficiencies

Let’s assume your current claim denial rate is about 20%. This means that for every five claims, one claim is denied. The biggest mistake that healthcare practices like yours make is accepting these numbers and getting used to them. When you start accepting the denial rate of your practice, you won’t think about the new ways to improve the revenue cycle management.

Are you aware about the fact that the average claims denial rate across most hospitals in the United States is between 6 and 13%? Now, it is time to compare yours and start taking corrective measures to improve it.

As a healthcare provider, you already face the constant burnout of long work hours, various complexities in treatments, and worries about the revenues generated. Therefore, most of the practitioners stay away from these nuances and accept the current effectiveness rates.

When it comes to the performances of billing and coding teams, it is important to check industry averages on a regular basis. Remember the fact that your practice is built on hard work and passion, hence it needs to optimize revenues and receive the money that it deserves.

Trying to manage everything on your own

There is nothing wrong in having an internal medical billing and coding team. This works for a lot of healthcare organizations, given the fact that the team would only focus on this practice and wouldn’t have other tasks.

However, it would be a smart decision to outsource Orthopedic Billing Services in the following scenarios:

  • You don’t have the right volume of patient to keep your internal team engaged all month long
  • You don’t have enough time to oversee the internal billing and coding team.
  • You have just started and hiring expert billers and coders may cause a huge dip in your initial investment cost

Times have changed and now your medical billing and coding doesn’t have to be so complex. Thanks to healthcare technology, the expert medical billing and coding team would stay connected to you like they are in the next room. So, the best decision would be to not ignore the prospects of outsourcing billing and coding, as it could be the game changer that you’ve been looking for in your revenue cycle management.


Streamline your Practice with Efficient Orthopedic Billing Services

Maximize Revenue with Expertise

By partnering with a reputable medical billing company like Eminence RCM and getting premium orthopedic billing services, practices can maximize their revenue potential. The professional team of experienced orthopedic billers and coders stay updated with the latest industry changes and regulatory updates. This ensures compliance and accurate claim submissions. Expertise and undivided attention help them to identify and rectify any coding errors or missing information promptly. This reduces the chances of claim denials and ensures timely reimbursements for the services offered by a healthcare provider.

Handling Complex Insurance Processes

The processing of insurance claims can be a time-consuming and complex task for an orthopedic practice. Right from verifying patient insurance coverage to submitting claims and following up on unpaid or denied claims, every step can be a significant administrative burden. Eminence RCM’s orthopedic medical billing services in USA take care of all insurance-related matters. In this way, healthcare providers can focus on delivering quality patient care without getting stuck in the complexities of insurance processes.

Advanced technology that ensures efficient workflow

To enhance the efficiency of orthopedic billing processes. Eminence RCM employes cutting-edge technology and streamlined workflows. By getting advanced billing solutions and electronic health records (EHR) systems, Eminence RCM ensures seamless integration, accurate documentation, and speeds up the claims processing. You will not only experience reduced paperwork and manual errors but also a better revenue cycle. This leads to increased cash flow for your orthopedic practice.

Better Revenue Cycle Management

To maintain financial stability, an efficient revenue cycle is crucial for orthopedic practices. Comprehensive billing services of Eminence RCM include timely submission of claims, accurate coding, follow-up on unpaid claims, denial management, and effective management of AR. By improving the revenue cycle management process, Eminence RCM helps orthopedic practices to optimize their financial performance and ensure consistent flow of cash.

As an orthopedic medical practitioner, your hands are to be already full. Therefore, it makes sense that you let experts take over the administrative tasks and focus on imparting patient care. Eminence RCM is one such flexible medical billing and coding partner for you. To ensure that your RCM processes are tweaked and made more efficient, our experts work dedicatedly towards satisfying your billing needs. This results in improved profits in the long run.

It’s time to unlock the growth potential of your practice with reliable and tailored Orthopedic billing services of Eminence RCM.

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