- Orthopedic-specific Coding & RCM
- Accurate Documentation & Modifier Use
- Full-Cycle Billing & AR Management
Streamlined Revenue for Orthopedic Practices
Our Orthopedic Billing Services
Insurance Eligibility & Prior Authorization
Verify coverage, benefits, and obtain pre-authorizations to avoid claim denials.
Patient Registration & Demographic Entry
Accurate capture of patient data, laterality, surgical details and payer information for clean claim submission.
Procedure, CPT/HCPCS & ICD Coding
Assign accurate codes for surgeries, injections, therapy, implants, and ensure compliance with payer and regulatory requirements.
Modifier & Global Period Management
Correct use of modifiers (laterality, bilateral, staged procedures, repeat surgeries, post-operative global periods) to avoid denials and maximize reimbursement.
Claims Submission & Tracking
Submit claims via EDI or paper, monitor payer responses, and track status until payment.
Payment Posting & Reconciliation
Post payments, manage adjustments, track patient balances, implant or hardware billing, and reconcile AR.
Denial Management & Appeals
Analyze denials, correct coding or documentation issues, re-submit claims or file appeals to recover revenue.
Clinical Documentation Improvement (CDI)
Audit operative notes, therapy, follow-up care and documentation to ensure medical necessity and compliance.
Reporting & Analytics
Periodic reports on denial rates, claim turnaround, implant utilization, revenue recovery and performance metrics to guide business decisions.
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Our Orthopedic Billing Workflow
We apply a structured, step-by-step billing workflow tailored for orthopedic practices — designed to reduce errors, speed up revenue cycles, and improve clean claim submissions.
Patient Intake & Eligibility Verification
Capture patient data, laterality, insurance details, benefits, and check for prior-authorization requirements.
Documentation Collection & Review
Gather operative notes, therapy reports, implant/supply documentation, medical necessity, and history.
Coding & Charge Entry
Apply accurate CPT, HCPCS, ICD-10 codes, modifiers, and enter charges based on services performed.
Quality Assurance & Coding Audit
Secondary review by certified coders to ensure documentation-coding alignment, correct modifier use, and compliance with payer rules.
Claim Submission & Tracking
File claims through EDI or paper, monitor payer adjudication, and track status until payment or denial.
Payment Posting & Reconciliation
Post remittances, adjust for implant/supply cost, reconcile patient balances, and update accounting records.
Denial Handling & Appeals
Investigate denials, correct coding or documentation, resubmit or appeal to maximize reimbursement.
Reporting & Analytics
Deliver regular financial and operational reports — denial trends, clean-claim rates, AR aging, revenue per surgeon/practice.
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