Offshore Orthopaedic Medical Billing Services Archives - InfoHub Fri, 22 Jul 2022 07:27:55 +0000 en-US hourly 1 Offshore Orthopaedic Medical Billing Services Archives - InfoHub 32 32 All You Want to Know About Orthopaedic Billing Wed, 23 Mar 2022 12:18:29 +0000 Orthopaedic billing requires sufficient documentation pertaining to a patient’s visit. All services performed must be meticulously documented and charged for by the billing staff. Errors such as incorrectly entering patient details or failing to check the patient’s eligibility before submitting a claim might result in a claim being rejected. In addition to permission problems, revenue collection might be hampered by a lack of knowledge of insurer preferences and deadlines. With so many complexities in orthopaedic medical billing, it’s critical for orthopaedic clinics to be adept with these codes for an error-free billing process.

It’s also crucial that your orthopaedic practice is aware of the most common claim denials so that you can prevent them. Duplicate claims or services are one of the most common grounds for denials in orthopaedic practices. The charge exceeds the fee schedule, which is another common basis for claim denials. Make sure your office keeps track of the most frequent denials’ primary causes. After that, you can put procedures in place to prevent future denials.

The following are some of the most effective ways to prevent denials:

  1. Ensuring that patient information is valid when it is obtained
  2. Confirming insurance verification is done properly
  3. Using a billing service that is automated

A few things to keep in mind while billing orthopaedic services –

  1. Laterality —ICD-10 and newer CPT codes require physicians to document right, left, or bilateral for a variety of diseases, such as fractures and joint disorders.
  2. Site Specificity – You’ll need to document the precise area of the body for many of the diagnoses your orthopaedic practise makes. 
  3. Place of OccurrenceICD-10 and subsequent coding changes need orthopaedic procedures to be more specific. Your office will be required to produce verification of where accidents occurred by payors.
  4. Type of Encounter – Orthopaedic physicians must document with sufficient specificity to allow coders to determine if the patient encounter was an initial one, a second encounter, or a sequela encounter.

Outsourcing As a Solution

Although recruiting and properly educating an in-house billing staff can help you avoid costly fees and penalties, the orthopaedic billing process is far too complex for an in-house team to handle. Outsourcing your orthopaedic billing and coding needs to a technologically advanced offshore medical billing company like Info Hub is one way to relieve burden on your personnel while also increasing reimbursement.

In many cases, outsourcing your practice’s billing and revenue cycle management lowers costs while increasing revenue. It can also save time for your employees when it comes to appealing or re-filing disputed claims. Outsourcing your billing can save you money, effort and time by avoiding the delays that can arise with an in-house billing staff due to unavoidable circumstances, vacations, and employee turnover. Overall, practises that work with a revenue cycle management business to handle billing and accounts receivable (A/R) see more revenues, decreased overhead costs, and better profitability.

Regular audit reviews, account monitoring, and follow-up with insurers are all part of Info Hub’s orthopaedic billing services. You will receive frequent reports outlining productivity, quality, and new revenue prospects while working with us. To fulfil the billing needs of orthopaedic providers, our qualified medical billing experts use industry standards and modern tools. It’s critical that your practice gets compensated fairly for the valuable services you provide. Your billing must be accurate and a timely order so that you are properly reimbursed.

Top 5 Challenges For Orthopedic Billing Services Thu, 03 Feb 2022 10:51:00 +0000

Orthopedics is the medical branch that deals with conditions of the Musculoskeletal system which include muscles, bones, ligaments, joints, and tendons. Orthopedic billing is more complex as it requires deeper knowledge of the providers’ services. It also has been noted that almost 35% of orthopedic surgery claims are incorrect and 25% of these claims get rejected. Out of that, some are never resubmitted. This branch includes many high-cost services and higher denial rates may lead to significant revenue loss. Hence, it’s important to understand the challenges and ways to tackle them.

There are a few factors that affected Orthopedic Billing largely.

  1. In 2013, CPT (Current Procedural Terminology) Manual introduced many new coding changes and revisions that affected orthopedic reimbursement largely. The coding became more complex with 500 changes in Category I codes.
  2. There have been new sets of codes in terms of nerve conduction study added to the system. Two sets for shoulder and elbow revision and even a new spine fusion. 
  3. The mix of varied personal injury liens, payers, and worker compensations can lead to inaccurate coding. It can further result in increased claim denials and delays in submissions.
  4. There have been disruptions in the cash flow due to an increase in practice costs.

The Top Challenges & Solutions for Efficient Orthopedic Billing

Errors in Coding

With varied codes for fractures or other injuries, coders may forget to add one code resulting in loss of revenue or denials. For example, if a person is treated for varied fractures with different surgical procedures, all the first procedures will have to be coded as initial encounters.

In the race of accuracy, there can be human errors during coding. The best bet is to conduct regular audits. It can help recognize bad unbundling habits, mistakes, or code overuse if any.

Adjusting to ICD-10 Changes

As the world shifted to ICD-10, many practices with limited resources struggled to meet requirements and maintain profitability. However, the new system brought in great changes that each provider needs to note –

  1. ICD-9 didn’t deal with laterality, but the new code sets require physicians to document in terms of left, right, or bilateral for different conditions like joint disorders or fractures.
  2. It now is compulsory to document the specific area of the body treated. If not mentioned correctly, claims can get denied.
  3. Orthopedic practices now need documentation about the place where the injuries occurred.
  4. You also need to specify whether the patient encounter was an initial, subsequent, or sequela encounter.

Verification and Documentation

The patient information and his/her insurance should be verified correctly before the treatment starts. COVID-19 has brought in several changes in insurance plans and coverage, so it is necessary to be more careful now. The billing team needs to document and carefully charge for each service availed by the patient.

Orthopedic billing depends on the documentation before, after, and during a patient’s visit. The lack of documentation from the physician report may leave several performed procedures being uncoded. Add-ons and modifiers cannot be left out as they are needed during reimbursements. A coder needs to understand the significance of the language used and the whole situation mentioned in the documentation. Similarly, physicians can learn/use the basic coding terms instead of narratives which can increase the chances of accuracy.

Staying Updated with Guidelines

CPT is the system that is used to code for encounters and treatments of patients. CPT and Medicare guidelines keep changing and the key is to stay updated. For example, you can code internal or external fixation only if it is not already a part of the basic procedure.

The surge in medical devices can also complicate billing. While the advice from manufacturers can be helpful sometimes, it’s better to research the Medicare guidelines. Avoid confusion and inaccuracy by looking up FDA approval status yourself while coding medical devices.

Claim Settlements

Research has noted that there has been an average decline of 1.5% in reimbursements every year. Errors may happen due to a lack of knowledge about the complex rules set by different insurance companies for examining a claim. Accuracy can be achieved by using the latest technology and keeping the staff updated with all the new rules.

Also, looking for the most common reasons behind denials and correcting them while resubmissions can help increase your reimbursements to a great deal.

Last but not the least, you need to maintain healthy practice revenues and increase physician reimbursement. You can increase the compensation with correct coding and well-maintained orthopedic claim documentation.

Outsourcing your orthopedic billing to an offshore medical billing company can save you from a lot of headaches like hiring and training staff, keeping them updated with changes, tracking all claims, and re-submissions if any. It’s time you rely on Info Hub Services for your orthopedic billing; to take care of timely claim submissions, regular audit checks, follow-ups with payers, and re-submission if any. Let us help you avoid loss of revenue and maintain good Revenue Cycle Management (RCM).

]]> 0
A Look At Orthopedic Billing Services Tue, 25 Jan 2022 11:05:08 +0000

The increasing complexity in Orthopedic billing services has made Orthopedic practices and individual practitioners to think to consider outsourcing. Before we get into benefits of outsourcing, it is important to know challenges in Orthopedic billing services. Orthopedic billing completely relies on proper documentation of pre, post and during patients’ visit to practice. Since the number of services provided by Orthopedic care is highly different from other diagnostic methods, it requires intensive focus on billing documentation.

Challenges in Orthopedic billing

Among several challenges in orthopedic billing, procedure codes for orthopedic surgery billing play a key role. Here are the coding challenges that any orthopedic care highly faces in billing:

#1: Incorrect codes

Billing related to fractures and their associated types can cause loss of revenue or rejection of claims if incorrect codes are applied while submitting claim applications. For example, when one or more fractures occur to patient with different surgical procedures, the initial encounters should only have all the first procedure codes to be specified during billing.

#2: CPT guidelines

A trained medical coder should know all the CPT guidelines and pay attention towards the terms used in physician documentation. With the changing medical billing guidelines of payers, it is mandatory to be up-to-date with the coding numbers and terms used during physician documentation. This will make sure that all the latest rules and guidelines are followed and implemented while claims submission.

#3: Appropriate anatomical coding

Anatomical coding is applicable only once per surgical procedure and should be billed individually for unique procedures when carried out to a patient i.e. one code for one procedure when performed. If multiple anatomical areas are operated, then multiple codes are applied. Most importantly, medical coders should have great expertise in understanding and specifying the appropriate anatomical location and laterality. This ensures accurate and flawless medical billing.

#4: Coding for Arthritis

While coding for arthritis, a coder should be highly careful since it involves no specific codes for primary and secondary arthritis. But recent changes in payer codes, within secondary arthritis, you can see multiple codes for post traumatic osteoarthritis and secondary arthritis too.

#5: External Fixation

Internal and external fixations are two different concepts in orthopedic billing. If internal and external fixation is not listed as part of the basic procedure, then the respective codes for both have to be specified while billing. Not only Medicare will have changing rules and guidelines for coding but also private payers may also have the same.


Orthopedic billing involves critical coding challenges and even requires orthopedic surgeons to be very skeptical and describe every action they perform during pre and post-surgical procedures. By doing so, it makes easy for coders to apply appropriate codes and help medical billers correctly bill and implement consistent and profitable healthy revenue management cycle.

To streamline your orthopedic medical billing system, an expert medical billing partner’s intervention is necessary. Info Hub can be your offshore medical billing company that has highly experienced billers and coders to submit clean orthopedic claims and stabilize your billing process.

]]> 0