When it comes to orthopedic billing, practices need to keep several important things in mind if they want to bill as effectively as possible and minimize the chance of claim denials.

In order for an insurance company to pay for any procedures performed by a healthcare organisation, billing codes must be put into place. Billing codes are established by the ICD-10 which has a code book for procedures, diagnosis, and drugs used in the treatment of patients. These codes contain seven alphanumeric characters that correspond to different aspects of a treatment.

Here’s the five orthopedic billing guidelines at the top of our list:

1. Verify Insurance Coverage

• Verifying insurance coverage can keep your orthopedic billing in tip-top shape and save time and money by preventing denials and coverage issues later on.
• Your orthopedic practice should be pre-authorizing and verifying coverage provided by the insurance carrier of every patient to ensure they have active coverage for the type of medical services you will be rendering.
• Make sure you also understand the reports their insurance company sends to you so you know how to interpret whether or not their policy covers the kind of medical care you are providing.

2. Double Check Patient Information

• This may seem like an obvious step to the orthopedic billing practices, but it never hurts to reiterate it’s importance.
• Always go over the spelling of patient names, their date of birth, as well as other demographical details that are easy to overlook or misspell.
• All of which could cause a rejected claim.
• These simple mistakes can cause issues down the line and lead to a rejected claim.

3. File Claims In a Timely Fashion

• Another simple billing mistake that can be avoided very easily is filing your claims on time.
• Create a process, standard procedures, and metrics to ensure that claims are submitted within a certain time frame.
• Additionally, you need to be well aware of the deadlines and “timely filing” limitations that insurance carriers have.
• Meeting these deadlines can be the difference between a denied claim and one that is paid.

4. Code as Specifically as Possible

• Sometimes, payers will deny billing claims on the grounds that they are not specific enough.
• Not only does your practice need to have as much information as possible documented to justify the codes selected.
• You also have to make sure they are using the correct codes for the procedure or service.
•  The switch to ICD-10 requires coding be more specific in order to be paid, it also means if you do not make your orthopedic billing and coding procedures compliant with the new system and coding standards you will not be paid properly or at all for your services.

5. Consider Outsourcing

• In many instances, outsourcing the management of your practice’s billing and revenue cycle actually decreases costs while increasing the revenue stream.
• It can also save your practice and staff time with appealing or re-filing claims that have been denied.
• Outsourcing your billing can save you from slowdowns that occur with an in-house billing staff .

Just like with other specialties, billing for orthopedic procedures differ according to criteria set forth in the ICD-10-PCS. Using these guidelines medical billing specialists can bill the proper procedures to a patient’s, insurance company, creating a more unified system of billing and coding.

We can make sure your practice is ready for ICD-10 with several certified coders and medical billing specialists.

Call us for a complimentary practice analysis http://localhost/main-site-update/free-practice-analysis/ to find out how your practice will benefit!