3 Steps to Avoiding Denials in Orthopedic Billing

Billing & Reimbursement EHR Medical Coding Orthopedics

avoiding denials his Making sure you get paid on insurance claims is a daunting task for any orthopedic office.  There are multiple reasons why claims get denied by insurance companies.  Many of them are easy fixes for office personnel, while others require time and attention or expert and detailed review by a certified professional coder.  The following are three top steps in avoiding billing claim denials.

The first step in this process is Always Verify Insurance.  The top reason medical billing claims are denied is for inaccurate insurance information.  Refresh diligence to the task of verifying insurance information with new and returning patients.  Contact the insurance provider and check dates and coverage periods.  Assess deductibles and collect copayments at time of patient visit.  Consider that every insurance policy has its’ limits.  Avoid errors when a patient’s maximum benefit is met or the patient is receiving services not covered by plan benefits.

Second step in avoiding denials in orthopedic billing is getting Accurate Patient Information.  30-40% (Univ. of MN) of bills submitted contain errors.  Simple errors can lead to annoying billing denials, beginning with patient information.  Become familiar with patient charts, check name and diagnosis code, and see that this information corresponds to the procedure performed.  Denials may be rebilled, but that will cause a delay in the payment process.  Also, make sure the front office staff analyzes the denials and then utilize that information to optimize claim processing and decrease the overall denials.

The third and final step mentioned here is to Automate the Billing Process as much as possible or Outsource it out to a company that specializes in processing orthopedic claims.  Incorporating a computerized claims scrubber that checks claims prior to submission, one that can be easily integrated with use of paper charts, would be of benefit.  Practices that decide to convert to EHR (electronic health records), can link a claims management system to their EHR to send claims to payers.  If you decide to use a claims processing billing company, make sure they use an EHR system and utilize effective claim scrubbing software.  Coding errors, a big snafu in the billing claims denial process, can be largely eliminated with these systems in place. 

In conclusion, billing denials can spell big trouble for an orthopedic office, however the preceding steps will assist in minimizing what can cost an orthopedic practice significantly in time and money.  As much as possible, consider the input of office staff and the entire group practice when deciding how to manage these denials in the orthopedic billing.