As per a statistic of the American Academy of Orthopedic Surgeons, there are around 12% of orthopedics who have a private practice. Others are a part of a larger hospital or are consolidated with other healthcare practices. In the United States, Orthopedics is one of the most popular healthcare specialties. Since, the last decade, this specialty has been immensely growing.
No matter if you are a private or a consolidated Orthopedic practitioner, you must take over the additional responsibility of taking care of the back end of the practice. You can choose to carry out medical billing and coding processes internally or consider outsourcing medical billing for Orthopedics. In both scenarios, you must have a deep knowledge of every nuance of the entire medical billing for Orthopedics.
In this blog, we will understand how Medical Billing for Orthopedics is carried out and how healthcare practices can eventually improve their collection process in the long run.
Were you familiar with the fact that most of the claims that are rejected or denied are because of the errors on the end of billing and coding team? You don’t have to do anything extraordinary to receive your payments on time. All you need is a robust billing and coding team like Unify Healthcare Services to handle your Orthopedic practice in an effective manner.
We have put together significant challenges faced while billing and coding for orthopedic practices and how they should be handled to ensure an efficient medical billing process.
Hurdles in Performing Medical Billing for Orthopedics
Check Your Prior Authorization Process
There is an AMA survey that states that it takes about 16 hours per week per healthcare provider to get prior authorizations. And in a complex process like orthopedics, this number even goes up to 30. If the prior authorization is not handled properly, it can increase the waiting period anywhere from one to five days. In this scenario, a patient may have to suffer without getting the right treatment.
The result is that the patient ultimately gives up on such Orthopedic practice when they regularly get long waiting periods for their prior authorizations.
To overcome this hurdle, you must check your prior authorization process and find out how it can be handled in the best possible manner.
Challenges in the Process of Coding
No matter what the healthcare sector is, there exist coding challenges in every sector. The specialty of Orthopedics is also the same. ICD codes are evolved regularly. If we talk about Unify Healthcare Services, the current version in use is ICD-10. However, the 11th version of ICD codes has been released. The expected implementation year for the same could be in 2025.
Therefore, all the codes and billers must be ready to relearn the entire procedure repeatedly. You can escape this process only if you have already started your journey towards ICD-11.
We are currently dealing with ICD-10. The coders must be vigilant about using the right modifiers and codes so that no payer is overcharged or undercharged. In case the smallest of errors arise, it can result in claim rejections. And you won’t get a fair payment for the services you provided as an orthopedic specialist.
Not Taking the Weaknesses Seriously
Let’s assume your denial rate is around 25%. That means one out of every four claims is denied. The biggest problem that private practices like yours could cause is accepting these numbers. If you start assuming the denials rate is about one-fifth of the total claims submitted, you wouldn’t start thinking about ways to improve this.
As a healthcare provider, you must face the constant burnout of long work hours, complexities in treatments, and worry about the revenues generated.
Therefore, most doctors stay away from these nuances and accept the current effectiveness rates of their medical billing and coding companies. There are usually no questions asked if their teams continue to match past performances.
Not Considering the Option of Outsourcing
You might have a strong internal medical billing and coding team. However, to handle the processes more diligently you need a team of experts by your side. This team can assist 24/7 with the operations of your administration.
It would be a smarter decision to outsource your in-house billing to professionals like Unify Healthcare Services in the following scenarios:
- Your healthcare doesn’t have the right volume to keep your internal team fully engaged.
- Lack of time to see the operations done by the in-house billing and coding team.
- You are at the beginning of your healthcare journey. In this case, maintaining an in-house team of billers and coders can be a costly affair.
How to Improve the Payment Collection Process for Your Orthopedic Practice
All Orthopedic practitioners struggle to balance the financial stability of their healthcare practice. We have already discussed the reasons for the declining revenue collections from payers and increasing expenses.
Let’s Discuss Some Practical Ways to Improve the Entire Orthopedic Billing Process
Share the Clear Estimate of Procedures
When it comes to orthopedic practice revenue collection, it is essential to clearly communicate the rough estimate of procedures. It is the first step towards ensuring price transparency. When you estimate all the financial obligations in advance, it helps to provide better customer service. Make sure to train your staff in better communication and coordination. When a patient is well-informed about his procedures and his financial obligations, it becomes easier for him to make better decisions.
Initiate Collections at the time of Providing Service
Your entire team must be well-versed with the monetary value of every CPT code and all the financial obligations. It ensures that the entire staff will be informed about the detailed information as soon as the patient checks in and can provide services accordingly.
Here, you can train your staff to go through and interpret patient eligibility clearly.
Properly Look into the Efficiency of the Collection Process
It is important to have a seamless and systematic approach to your collection process. You must take care of your payments on both ends - insurance companies and patients. Prepare various report formats to store the data collected in the entire process. You can consider reporting formats such as weekly patient/insurance collections, write-off amounts-patients, number of denied claims, AR amounts, and others.
To initiate a smooth collection process, you can just set a few collection rules and try to follow them strictly.
You might have an efficient in-house team to handle Medical Billing for Orthopedics, but it is not always possible to monitor them. In this situation, things might become complicated. Therefore, it would be a smart decision to outsource your orthopedic billing and coding requirements to an expert like Unify Healthcare Services. This will help to eliminate stress and result in an improved orthopedic collection process.
