5 Orthopedic Billing Guidelines

Billing & Reimbursement

The billing process in the revenue cycle is one of the most important functions for orthopedic practices today. With proper billing, revenue will continue to come in with minimal delays minimizing stress and cash flow issues. When it comes to orthopedic billing, practices need to keep several important things in mind if they want to bill as effectively as possible and minimize the chance of claim denials. Here’s five orthopedic billing guidelines at the top of our list…
1. Verify Insurance Coverage


One way to keep orthopedic billing efficient and profitable is taking time to verify all aspects of insurance. Your orthopedic practice should be pre-authorizing and verifying coverage provided by the insurance carrier of every patient to ensure they have active coverage for the type of medical services you will be rendering. Make sure you also understand the reports their insurance company sends to you so you know how to interpret whether or not their policy covers the kind of medical care you are providing. Verifying insurance coverage can keep your orthopedic billing in tip-top shape and save time and money by preventing denials and coverage issues later on.

2. Double Check Patient Information

This may seem like an obvious step to the orthopedic billing practices, but it never hurts to reiterate it’s importance. Always go over the spelling of patient names, their date of birth, as well as other demographical details that are easy to overlook or misspell. All of which could cause a rejected claim. These simple mistakes can cause issues down the line and lead to a rejected claim. Have your administrative staff go over intake forms that your patients fill out to make sure the information you receive is consistent with what you process on your claim.

3. File Claims In A Timely Fashion

Another simple billing mistake that can be avoided very easily is filing your claims on time. Create a process, standard procedures, and metrics to ensure that claims are submitted within a certain time frame. Additionally, you need to be well aware of the deadlines and “timely filing” limitations that insurance carriers have. Meeting these deadlines can be the difference between a denied claim and one that is paid.

4. Code As Specifically As Possible

Sometimes, payers will deny billing claims on the grounds that they are not specific enough. Not only does your practice need to have as much information as possible documented to justify the codes selected, you also have to make sure they are using the correct codes for the procedure or service. The switch to ICD-10 requires coding be more specific in order to be paid, it also means if you do not make your orthopedic billing and coding procedures compliant with the new system and coding standards you will not be paid properly or at all for your services. Be sure your staff and providers have the necessary resources and expertise to be able to document and code your claims accurately and and to the highest level of specificity.

5. Consider Outsourcing

In many instances, outsourcing the management of your practice’s billing and revenue cycle actually decreases costs while increasing the revenue stream. It can also save your practice and staff time with appealing or re-filing claims that have been denied. Outsourcing your billing can save you from slowdowns that occur with an in-house billing staff because of illness, vacations, and also protects against the hassles of employee turnover. Overall, practices who partner with an expert revenue cycle management company to manage the billing and accounts receivable (A/R) see increased revenues, lower overhead costs, and maximized profitability.

It is imperative that your practice is getting paid what you should be for the valuable work you provide. To ensure you are compensated properly, your billing needs to be completed accurately and in a timely fashion. For more information about revenue cycle management and orthopedic billing services as well as other tips to increase medical reimbursements, get in touch with us.