Intricacies of Orthopedics Medical Billing Services and Tips to Streamline Revenue Cycle
Without any debate, medical billing and coding is an essential part of the healthcare industry. It is a complicated process as it involves translating medical procedures, diagnoses, and treatments into standardized codes for the purpose of billing and reimbursement. When billing and coding is done accurately, it ensures that healthcare providers receive timely and appropriate payment.
Orthopedic services are a specialized area of medicine which deals with the diagnoses, treatment, and prevent musculoskeletal disorders. These disorders in Orthopedic range from minor sprains and strains and more severe conditions including fractures, arthritis, and joint replacements.
Orthopedic medical billing services require specialized knowledge and expertise. This ensures that the correct codes are used to reflect the services provided in the healthcare practice. If we talk about the recent years, there have been significant changes to the medical billing and coding system. This includes the transition from ICD-9 to ICD-10 coding and the implementation of various reimbursement models.
These changes have resulted in making Orthopedics medical billing services more complex. Today, providing Orthopedics medical billing services requires ongoing education and training to stay current with the latest updates and regulations.
This blog will provide you with an overview of medical billing and coding for orthopedic services. You will get to know the challenges faced, effective ways to tackle them and how Unify Healthcare Services emerges as the right choice for your medical billing needs.
Let’s Begin
Which Services Are Included in Orthopedic Medical Billing?
The services begin at the time of patient entry into the orthopedic practice for treatment. To get properly reimbursed, it is essential to ensure that these aspects of the orthopedic billing process are performed correctly.
- Verify the patient’s insurance eligibility
- Proper entry of patient demographics
- Documentation and coding of services and procedures performed
- Timely claims submission
- Reprocessing denied claims
Doing prior authorizations
As per an AMA survey it takes about 16 hours every week for every healthcare provider to get prior authorizations. And sadly, if we talk about orthopedic practices, this number reaches up to 30. If prior authorizations are not handled precisely, it can leave a negative impact on the healthcare provider. Apart from that the patients may suffer. They might have to wait anywhere from one to five days without getting the right treatment.
Because of the long periods for prior authorization, various patients give up on such practices that they use to visit regularly before. As a healthcare provider, it comes down to you to check your prior authorization process regularly. After that you’ll need to find out how effectively it is handled.
Thankfully, with the advancements in technology there are various options available in the market that provide Orthopedic medical billing services and handle your administrative burden. However, the important part is that you must choose the one that aligns with your Orthopedic billing requirements.
Don’t worry, you don’t have to waste your time on research. If you are looking for an orthopedic medical billing service provider for your healthcare practice, Unify Healthcare Services is the right option.
Complexities in Coding Process
The challenges in medical coding arise in every healthcare sector and Orthopedic is no exception. The reason is that the ICD codes are updated on a regular basis.
ICD-11, which is the eleventh version of code updates, has already been released. The version came out in January 2022. Its expected implementation year could be 2025 for all the healthcare practitioners, medical billing and coding companies. This means your healthcare practice must be ready to adapt to the changes.
Soon, all the orthopedic coders and billers will have to unlearn and relearn again. So, if you don’t want to lag behind, it is better that your coding and billing team has already started the process.
In the currently used CPT list, coders must be careful about using the right modifiers and codes. This can save the healthcare practice from getting overcharged or undercharged by the payers. Even a small error can take you toward claim denials and rejections. It means you will not get the worth of services provided.
Normalize inefficiencies
Inefficiencies are common in medical billing, but the problem is getting comfortable and not doing anything about them. As soon as you start to accept the denial rate of your practice, you won’t make strategies to improve the revenue cycle management.
Do you know that the average claims denial rate across most hospitals in the United States is between 6% to 13%? For an efficient healthcare practice, it is time to compare and start taking corrective measures to significantly improve it.
However, another fact is that you already face the constant burnout of long work hours as a healthcare provider. There are various complexities in treatments and worries about the revenues generated. And to stay away from the nuances, most of the healthcare practitioners accept the current effectiveness rates.
When it comes to the performances of billing and coding teams, it is important to check industry averages on a regular basis. Remember the fact that your practice is built on hard work and passion, hence it needs to optimize revenues and receive the money that it deserves.
Making an effort to manage every process on your own
There are various healthcare providers who have an internal medical billing and coding team. And there is nothing wrong with that. It might work for a lot of healthcare organizations. But it is only possible if the team is focused on just carrying out coding and billing tasks.
Best Practices in Orthopedics Medical Billing and Coding
Precise Documentation
When it comes to orthopedics medical billing and coding, accurate documentation is the most important part. It is important for Orthopedic practices to maintain detailed records of patient visits, procedures, and services that have been provided. In case there are any errors or omissions in these records, it can directly lead to claim denials and delay the reimbursement. For this, it is crucial that you have a deep understanding of medical coding and terminology. This ensures that all the relevant information is documented correctly.
Insurance Verification
Before any claim is submitted, one thing to consider for orthopedic practices is that they need to verify that the insurance plan of a patient covers. If they fail to do so, it can lead to claim denials and may create disputes with patients. Therefore, insurance verification is a crucial step to ensure that the entire orthopedics medical billing process is carried out smoothly.
Specific Coding with timeliness
Orthopedic procedures are complex and diverse in nature. Therefore, for the right representation of the services provided during a patient’s visit, accurate coding has a crucial role to play. Right Current Procedural Terminology (CPT) codes must be used. They must align with the specific diagnosis and services provided by a healthcare provider. Ensure that the coders are updated with the latest coding changes and guidelines.
Prioritize Payment Collection
One common observation is that encouraging patients to pay for orthopedic services at the time of their appointment can enhance the cash flow of the organization. This also helps in reducing the chances of delayed payments. Submitting charge tickets efficiently and process patient payments to help boost collections.
Orthopedics is a medical specialty where the smallest of billing omissions or coding errors can lead to high losses in the revenue of your healthcare specialty. The medical billing and coding team must work hard to maintain a proper cash flow within the organization. That is where a medical billing and coding company like Unify Healthcare Service can help.
