What Is Orthopedic Billing?

What Is Orthopedic Billing

A healthcare organization’s revenue cycle management includes several phases, one of which is medical billing. The process involves creating, submitting and following up on claims so your organization can compensate for your services. But what is orthopedic billing?

Considering the topic’s importance, we decided to share our expertise with you and explain orthopedic billing in detail, from defining the term to compliance considerations and optimization tips.

What Is Orthopedic Billing?

Orthopedic medical billing involves submitting and managing claims for orthopedic services to receive reimbursement.

Orthopedic billing’s primary goal is to ensure that healthcare practitioners, clinics or other facilities specializing in orthopedic care are properly reimbursed for their services. It is a crucial phase of the revenue cycle that ensures timely claim collection.

Main services included in orthopedic billing

Orthopedic billing includes various services. The billing process can start either with insurance verification or with patient registration. These two steps are important because they ensure error-free billing and minimize the chance of denied claims.

Next, while the patient receives orthopedic treatment in your facility, proper documentation is needed so the medical coding and billing process can proceed smoothly. Once all the orthopedic treatments and services the patient receives are translated into codes, a claim to the insurance company is submitted.

Then comes the claim submission and management process. One of the many benefits of outsourcing your medical coding and billing process with CLICKVISION BPO is timely claim submission, enhanced accuracy, and effective denial management

Importance of Orthopedic Medical Billing

The basics of orthopedic medical billing are incomplete without an understanding of the process’s importance. First and foremost, accurate orthopedic billing ensures steady cash flow, which is essential for the organization’s operation and financial security.

Furthermore, efficient and accurate orthopedic billing is key for revenue optimization and revenue cycle management. Orthopedic billing is also crucial for:

  • Patient billing transparency
  • Financially supporting ongoing patient care
  • Streamlining operations
  • Compliance with healthcare regulations
Importance of Orthopedic Medical Billing

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Coding and Documentation in Orthopedic Billing

Incomplete documentation and coding errors are some of the most common mistakes in orthopedic billing and the reasons for claim denial. Our complete orthopedic medical billing services ensure that all required documentation and the claim are sent to the payor. This includes, but is not limited to:

  • Patient medical history
  • Physical examination (measurements, observations, and findings)
  • Diagnosis
  • Treatment plan
  • Progress notes

We also have highly experienced medical coders to minimize or eliminate coding errors that might slow down the reimbursement process.

Compliance Considerations in Orthopedic Billing

There are orthopedic-specific requirements regarding documentation and medical necessity criteria that have to be followed. To lower your organization’s administrative burden and benefit from a seamless orthopedic billing process, you should entrust it to professionals with years of experience, like our CLICKVISON BPO team.

To illustrate, we will ensure your orthopedic billing process is compliant with:

  • HIPAA: Adhering to the privacy and security rules during the entire orthopedic billing process.
  • Orthopedic CPT codes: For identifying and classifying orthopedic-related surgical, medical or diagnostic interventions.
  • ICD-10 codes for Orthopedics: Coding according to the medical classification list by the World Health Organization.
  • Affordable Care Act: Ensuring that orthopedic services and treatments are affordable.
  • Medical Fraud and Abuse Regulations: For preventing, detecting and reporting fraud and abuse.
  • Payor policies: Adhering to the specific claims policy of the insurance company.

As a healthcare organization, it should be your priority to work according to the latest regulations and laws. Failure to do so might lead to denied claims, penalties, and high fines.

Reimbursement Strategies for Orthopedic Services

The reimbursement process can take time if it is not done according to the regulations or handled by experienced billers. If you have an in-house orthopedic billing team, you should create revenue cycle management strategies for handling different situations. Here are some insights into how we handle the reimbursement process:

  • Proper coding
  • Attaching all necessary documentation regarding the claim
  • Timely submission of claims
  • Double-checking for data accuracy
  • Maintaining constant communication and good relationships with insurance companies
  • Understanding the payor see schedules
  • Considering bundling and unbundling, etc.

Billing Process Optimization in Orthopedic Practices

Orthopedics workflow optimization is essential for improving efficiency and enhancing revenue cycle management. It can be achieved by following different practices.

For instance, the utilization of electronic health records, or EHR, is one of the softwares that can help with orthopedic billing and revenue cycle management. EHR allows the automatization of the billing workflow.

Moreover, a study showed that orthopedic providers have noticed an increase in Medicare outpatient visits. At the same time, the EHR implementation allows more efficient patient data collection and management.

In addition to the EHR, as a healthcare organization, you can utilize different billing software to streamline your workflows. Depending on the medical billing software you chose, you can potentially benefit from:

  • Reduced paperwork
  • Minimized manual work and human-made errors
  • Accessibility of patient information from different locations
  • Claim tracking
  • Streamlined and efficient coding, etc.

Outsourcing Options for Orthopedic Billing

Orthopedic billing tasks can be handled by an in-house medical billing team or outsourced. In-house orthopedic billing requires a highly experienced team and many resources. 

As a more effective and affordable option, many healthcare organizations decide to outsource their billing. The list of benefits you will get by outsourcing orthopedic billing is long, but the most important ones include:

  • Access to experienced medical billers
  • Reduced billing costs
  • Minimized errors
  • Guaranteed compliance with the latest regulations
  • Faster reimbursement
  • Enhanced transparency
  • Higher patient satisfaction
  • Efficient workflows
Outsourcing Options for Orthopedic Billing

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So, what is orthopedic billing? It involves the systematic submission, processing and management of claims for orthopedic services, treatments and diagnoses.

Orthopedics is a complicated medical branch that involves processes regarding the prevention, diagnosis and treatment of the muscle and skeletal system. While patient care entirely depends on the expertise of your medical personnel, you don’t have to worry about getting compensated for your services.After obtaining all the information, it is time to decide whether your organization would be better off outsourcing the billing process. Before you decide, schedule a free consultation call to learn how our CLICKVISON team can help you outsource revenue cycle management and achieve accurate coding, documentation and compliance with the latest regulations.

With a strong background in the marketing industry and healthcare leadership roles, Filip is responsible for CLICKVISIONBPO's sales strategies and onboarding new clients. With a passion for sharing insights gained from his experience, he also shares valuable knowledge through industry related articles.