How Specialized Billing Service Helps Prevail Over Unique Orthopedic Billing Challenges

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End to End Medical Billing Solutions

           How Specialized Billing Service Helps Prevail Over Unique Orthopedic
                                     Billing Challenges
       Orthopedic billing has its own share of challenges that seem to get complex with changes in orthopedic-
       specific CPT codes and modifiers every year or as deemed fit whenever by the governing body for
       monitoring and recommending coding changes. Quite parallel to this challenge is the orthopedic fee
       schedules (published by the CMS), which are progressively becoming smaller every year. In between these
       two, orthopedic billing and coding environment continues to be influenced by technology so much so that it
       is virtual impossible to conduct operational functions without being compliant with the requisite degree of
       automation. The sum total of these three challenges puts so much pressure on orthopedic physicians that
       they are left with no option but to entrust their orthopedic billing to specialists outside their clinical facilities.

       Orthopedic medical billing specialists can bring a host of services to the table, notably of which are:

               • Medical coding
               • Medical billing
               • Denial management
               • Complete AR Follow up
               • Weekly and Monthly reports
               • Feedback to providers

       This array of value-added services can translate into real benefits to providers, such as:

                  •   Decline in account receivables; orthopedic facilities can expect to realize their claims
                      within 60 days from the day of submitting claims either electronically or manually
                      through paper submission.

                  •   Opportunity to focus intensively on patient care as the operational side is entirely looked
                      after by orthopedic billing specialists

                  •   Uninterrupted claim reimbursements as changing coding regulations are handled by
                      orthopedic specialist coders.

                  •   Availing patient billing statements to verify against the actual submission of patient

                  •   Getting denied claims resubmitted with necessary supportive documents or having them
                      appeal and adjudicated with attorneys concerned.

                                                Copyright ©-2013 M.D.C.P. All Rights Reserved.
                                                                                                                 Page 1 of 2
End to End Medical Billing Solutions

       Therefore, it is vital that orthopedic facilities or physicians source services from orthopedic medical billing
       specialists that are acquainted with evolving changes in orthopedics codes and payer requirements, which
       will ensure that your claims are submitted accurately in time to have them reimbursed as early as possible.
       Amongst the traits that define orthopedic billing specialists are their being knowledgeable of:

            •    Complex orthopedics billing codes and rules
            •    Orthopedics-related terminology
            •    Office notes and operative notes
            •    Coding for surgical procedures
            •    Code variations related to multiple procedure rules

       While orthopedic physicians may be required to assess their prospective orthopedic billing specialists’
       competence, offers them ready pool of resources that have verifiable
       credentials for being consistent with evolving orthopedic medical billing practices and technology systems.
       Thus, orthopedic physicians can expect to have:

                  •   Their account receivables managed effectively

                  •   Access to round-the-clock claim processing

                  •   Patients’ insurance verified through system-based eligibility

                  •   Their medical billing updated consistently with coding updates as and when they occur

                  •   System-based claims scrubbing

                  •   Addressing billing-related issues over secure, sophisticated, and swift communication

                  •   Quality assurance checks conducted at regular intervals

                  •   Weekly or fortnight progress reports on claims under process

                  •   Their orthopedic reimbursements maximized as far as possible

                  •   Their practices compliant with HIPAA standard for ‘Meaningful Use of EHR’, which has
                      come to be recognized as the yardstick for measuring orthopedic physicians’ competence
                      for clinical and operational excellence

                                              Copyright ©-2013 M.D.C.P. All Rights Reserved.
                                                                                                               Page 2 of 2

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Description: One of the most exasperating occurrences during medical billing for a practice and its billers is a denied claim, as it equals to efforts resulting in non- payment as well as resubmission of the claims.