Simplify Orthopedics Medical Billing to Maximize Reimbursement

Trying to maintain a balance between administrative tasks and medical billing can lead to exhaustion.

Orthopedics go through similar difficulties when they try to take everything into their hands.

It would be fair to say that orthopedics is a busy branch, occupied with a multitude of patients. Orthopedics medical billing can lead healthcare providers to stress and burnout.

When it comes to the size of a practice, small-scale healthcare providers can choose to do orthopedics medical billing by themselves. However, in the case of large-scale medical practices, it can get quite complex.

On top of that, medical billing comes with a lot of nuances that need expert knowledge and skill for positive results.

Whatever healthcare providers choose, the aim is to organize the medical billing process and lead to adequate reimbursement. For this, healthcare providers either hire an in-house medical billing staff or opt for outsourcing.

In this blog, we will learn how partnering with medical billing services is the ultimate choice for orthopedics medical billing.

Before that, we will look at some of the major drawbacks that prevent healthcare providers from achieving their goal of optimum revenue.

Let’s get straight into the factors that are preventing healthcare providers from improving their bottom line.

Major Drawbacks in Orthopedics Medical Billing

Basically, we will discuss various issues in the medical billing process that prevent healthcare practices from achieving a better financial status.

We will go step by step to understand the concept entirely:

Faulty Insurance Verification

Patient’s insurance eligibility is vital and the reason behind this is directly related to insurance coverage. So, checking eligibility ensures a reduction in monetary risk. It also gives a green flag to continue with the process further.

A failure or faulty insurance verification can cost healthcare providers and lead to denial of claims. That is why proper verification is a must for any healthcare provider.

Mistakes in Demographic Entry

Accurate entry of patient demographic information is necessary to avoid denial of claims. In orthopedics medical billing, it becomes even more important to keep each entry correct and avoid any mistakes.

The errors can be anything ranging from wrong date of birth or misspelled name. This is a drawback that prevents healthcare providers from making financial improvement.

Inaccurate Documentation

Documentation is essential to keep a record of medical procedures and treatments. These medical reports are later used to translate into codes for accurate claim filing.

Inaccurate documentation is also the reason behind faulty coding that leads to denial of claims.

Coding Errors

The medical billing process is a combination of accurately documenting and presenting various treatments, diagnoses, and procedures. One major aspect of orthopedics is surgery, and this expands the scope of codes.

The more complex procedures, the trickier its medical billing is.

This imposes a need for medical billing professionals as experts can handle coding better and prevent common mistakes.

To ensure that claims are filed correctly, healthcare professionals need to ensure the accuracy of CPT and ICD codes along with the right modifiers.

Two Major Mistakes in Orthopedic Coding are:

• Unbundling: Maximum mistakes happen while coding separately for a condition that involves many components.

For Illustration
The three parts of the knee such as medial, lateral, and suprapatellar have different codes. Only a clear understanding of the difference between the codes can lead to accurate claim filing.

• Modifiers: Modifiers are as important as CPT and ICD codes, wrong modifiers can lead the practice to revenue leakage.

For Illustration
Correct usage of Modifier 59 has a significant role in orthopedics billing and coding. Healthcare providers must use level I and level II modifiers with precision to get adequate revenue.

There is no doubt that medical coding is the most challenging part of orthopedics medical billing.

To prevent harsh consequences, healthcare providers need to look for solutions that can improve the revenue cycle and enhance operational efficiency.

Medical billing services can shift negative outcomes into positive outcomes for healthcare providers with their essential services. As they work with expert coders, they are able to eliminate the coding errors and uplift the financial posture.

Untimely Claim Submission

Submission of claims is a vital part of the process and healthcare providers make more mistakes during submission than we can think of.

The issue is the untimely submission of claims in orthopedic medical billing. Preventing denials and a need to refile the claims can be avoided with on-time submissions.

But what is the right time for submissions?

It is the time frame stipulated by the insurance companies and healthcare providers must submit claims within that time.

All these drawbacks contribute to the denial of claims, but they all can be avoided with some tips.

Top Tips to Prevent Claim Denials

Here’s quick review to prevent denials and protect revenue:

• Take the verification process seriously and don’t miss any vital details
• Maintain the accuracy of patient information at the time of documentation
• Keep up with the billing and coding standards and stay up to date with the changes
• Make sure to submit claims within the time frame
• Follow up on the denied claims with a proper denial management plan 

As a healthcare provider, you need to make sure that the administrative tasks of your practice run smoothly. As a result, you can achieve adequate reimbursement and improve the workflow as well.

Especially for orthopedics, you must ensure accuracy in every step of the process for exceptional results.

Other than all the above-given advice, one more unavoidable practice to ensure complete compensation is compliance.

As a healthcare provider, never miss any details of HIPAA and take every vital measure to fulfill the necessary requirements. Protecting sensitive patient information from misuse is a must to avoid legal actions and reputational damage.

We have discussed all the reasons for revenue loss and shared some of the crucial tips to maintain the financial soundness of your orthopedic practice.

However, juggling between two major tasks can be extremely challenging for healthcare providers. As a result, outsourcing orthopedics medical billing can be a wise decision for healthcare providers and practices.

Medical billing services can bring the most sought-after results for your healthcare practice.

If you are considering outsourcing medical billing for your practice, then Eminence RCM can deliver the results you are looking for.

Let’s see how Eminence RCM can make a difference in your healthcare practice

Choose Eminence RCM as Your Orthopedics Medical Billing Partner

Eminence RCM is the medical billing specialist you are looking for. Our team holds expertise in medical billing and coding for the specialty of orthopedics. We have a wide range of solutions to the complexities of medical billing.

Being an orthopedics medical billing company, we can add value to your healthcare practice with efficient results. Maximize your revenue and boost the bottom line with the accurate medical billing services of Eminence RCM.

Experience Complete Satisfaction with Customized Solutions Such as:

• Thorough insurance verification
• Complete and accurate documentation
• Skillful coding for every orthopedic treatment and procedure
• Zero errors in claim filing
• Timely submission
• Compliance with all regulatory standards
• Transparency in all services
• Denial management
• AR management and follow up
• Complete reporting of the entire medical billing process

Eminence RCM understands your needs and delivers services according to that. All our efforts are towards following a proactive approach to prevent potential issues. We work deliberately to free you from the administrative hassle, so that you can devote all your attention to patient care.

Get premium medical billing services and reach your financial goals with Eminence RCM. Contact Now or Book a Free Demo!