orthopedic medical billing


By Alex James

Top 4 Orthopedic Medical Billing Challenges for Practices

To specify what has been treated and how it was handled, orthopedic surgeons use a system of standards and practices called “Orthopedic Medical Coding and Orthopedic Medical Billing.” One of the most important aspects of managing a successful orthopedic practice is billing and coding for orthopedic surgeons. Orthopedic billing and the right coding practices ensure that money comes in quickly, relieving pressure on your company’s cash flow. One of the most prevalent problems that orthopedics clinics encounter are denials, and skipping precautions might cost significant money.

If you practice orthopedics alone or as part of a group, you must also handle the administrative side of your practice in addition to seeing patients. While some doctors manage their Orthopedic Medical billing independently, others work with outside medical coding and billing companies. It is necessary to understand the profession’s complexities regardless of your route.

What Do You Mean by Orthopedic Medical Billing?

One of the most common medical specialties in the US is orthopedics. Did you know that during the past ten years, this industry has grown in size? According to the American Academy of Orthopedic Surgeons, about 12% of orthopedic surgeons maintain a private practice. The remainder, however, is either combined with other practices in other medical specialties or integrated into larger facilities.

It covers each stage of the claim submission process, ensuring that all supporting evidence is valid and that a medical necessity is there, among other things. Monitoring A/R collections, following up on claims, making adjustments, and meeting filing deadlines are also crucial in orthopedic medical billing and coding.

Did you realize that the payer denied or rejected many claims because the billing and coding staff committed errors? You may increase your revenue without doing anything special by just resolving these avoidable mistakes.

The experts at NEO MD have identified four key problems with orthopedic medical billing and coding. They have also provided an explanation of how NEO MD resolves each problem.

Orthopedic Medical Billing
Orthopedic Medical Billing
  • Getting Prior Authorizations

According to an AMA study, obtaining prior authorizations takes each healthcare provider roughly 16 hours weekly. This number may reach 30 when it comes to orthopedic Medical Billing. Prior authorizations can cause delays in treatment for your patients of one to five days if the medical billing and coding businesses don’t handle them properly.

  • Coding Challenges

All areas of healthcare have coding issues, and orthopedics is no exception. The ICD code currently in use in the United States is ICD-10. Health care professionals and orthopedic medical billing and coding companies in the United States may implement this version by 2025.

Here are a few typical orthopedic coding errors:

  • Bundling error – For instance, whether the scheduled injection or the series injection were completed on the same day, the EM services were not individually billed. In contrast to injections or other bundled services, EM services can bill with a modifier 25/24/57 if they are not scheduled or a follow-up for injection with a specific diagnosis.
  • NCCI edits: When billed with group 1, the NCCI modifier is not coded with the group 2 code; however, once the modifications have been confirmed and are in effect, we can add modifier 59 to the group 2 codes and submit the claim. In the examples below, 
  • 20610 (General Introduction or Removal Procedures on the Musculoskeletal System) and 64461 (Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Proceedings on the Somatic Nerves) are two instances. The 59 modifier is inapplicable.
  • 20610 & 20553 (trigger point injection) You may add the modifier 59 to bill 20553.
  • Medical Necessity – For instance, if we bill for the injection of a diagnostic or therapeutic agent into a facet joint at the cervical or thoracic level (64492).  In addition to injecting a diagnostic or therapeutic agent into a facet joint at the sacral or lumbar level (64495). The procedure will only reimburse on appeal if there is sufficient documentation of the patient’s medical necessity.
  • All treatment codes should bill with the GP or GO modifier (indicating care plans for physical therapy). The Medicare yearly treatment cap is $2150.00. We must provide the KX modification and documentation of medical needs of extra services.

With back-end adjustments that can be designed to catch these problems for auto and human coding, such errors may be completely eradicated. This tool is the clever work of thousands of professionals and millions of interactions. It’s time to introduce automation and efficiency if your team is still managing the coding component manually.

NEO MD Medical Billing professionals have moved invoices from encounter to claim using robust procedures in less than 24 hours. An Orthopedic medical billing and coding service like NEO MD will completely change the coding aspect of your billing operation, guaranteeing that you begin seeing decreased rejection rates and more revenues immediately.

How does NEO MD handle orthopedic medical billing for its partner practices?

Medical billing and coding procedures may be highly intricate. Therefore, from an economic or strategic perspective, managing these processes internally might not be the best approach to take. Maintaining compliance with the laws and regulations as they change over time is another difficult chore for medical facilities. Orthopedic Medical Billing and other emergency room codes are unusual as a result of the industry’s fast evolution. Therefore, outsourcing medical billing to NEO MD will be profitable as our billers and coders already have a strong reputation in the industry.

You may expand your practice with the support of our dedicated staff of medical billers and coders. Our staff strictly follows all CMS Orthopedic Billing guidelines to achieve optimal reimbursement. The likelihood of claim denial and refusal is decreased by coding each claim in real-time, swiftly, precisely, and without errors, as well as an early examination to confirm claim eligibility. Leading US revenue cycle management companies are in charge of many recently built healthcare facilities.

NEO MD’s orthopedic billing services are frequently rated as the finest in the US compared to other revenue cycle management companies. Moreover, NEO MD offers Medical Billing services for small practices, medium, and large offices. Additionally, we provide practices in all US states with specialized billing services. Therefore, the healthcare facilities might locate the top Medical Billing company near me to acquire our services.

What Makes NEO MD the Best Orthopedic Billing Services Company?

NEO MD stayed best among competitors in terms of providing good Revenue Cycle Management services to practices due to the following cores;

  • Our experts work hard to reduce your front-end denials by 20%.
  • Offer Provider & Staff Productivity Analysis
  • Out of Network Negotiations.
  • Provide fortnightly financial and practice overviews 
  • Identify potential under, over, and incorrect coding scenarios
  • Refunds adjustment and Payment posting to improve the cash flow.
  • Regular updates on coding compliance
  • Use the latest technology and tools to ensure the accuracy of claims and faster collection.
  • Offer Services that are easily scalable at all times 
  • Offer internal Medical Billing audits to uncover loopholes
  • Improve RCM system efficiency with a robust credentialing team. 
  • We have consistently increased the collection rate (Orthopedic Medical Billing) for our clients. denned

Let’s schedule an appointment and discuss it in-depth with Medical Billing and Coding specialists. Contact us now at ([email protected]) or (929) 502-3636).

Orthopedic Medical Billing
Orthopedic Medical Billing


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