Orthopedic Billing – All You Wanted To Know!

ORTHOPEDIC BILLING – ALL YOU WANTED TO KNOW!

Did you know that 35% of the claims made in Orthopedic surgery are incorrect, and 25% of them get rejected? If you ask an orthopedic medical professional, they will tell you that orthopedic coding and billing are tedious and, in medical schools, they aren’t taught very well. However, when practice starts in real life, it is essential to get knowledge for getting paid for the services provided while dealing with the following complexities.

• Orthopedic Billing Complexities

The new ICD-10 has revised 134 codes, deleted 143, and added 264 new codes in orthopedic coding. Furthermore, the introduction of modifiers like XU, XE, XP, and XS is quite path breaking in the field, accompanied by the new rules for modifier 59. All these recent changes and the existing medical coding and billing practices in Orthopedic make the process quite complex.

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BEGIN WITH USING THE CORRECT MODIFIERS

The two-character designators used in Orthopedic billing denote how the procedural codes and services are to be applied for the services so the reimbursement can be claimed. When these modifiers are used accurately, they can provide an accurate and detailed medical record of the transaction. In orthopedics, there are two levels of modifiers, Level I and Level II. The Orthopedic billers and coders must have an indepth knowledge of the modifiers and the codes that are suitable and permissible for a service provided. Any misuse of the modifiers and codes can lead to claim rejection, denial, fines, and in rare cases, even investigation of the practice. https://www.247medicalbillingservices.com

What Else? Top 5 Billing Guidelines for Orthopedic Practice

• Insurance coverage verification

From the beginning, the best way to keep the Orthopedic practice efficient is by taking the time to understand the patient’s insurance policies and verify the aspects of it. It must include pre-authorization, verifying the coverage given by the insurance company, and the type of orthopedic medical services it covers.

• Checking patient information The importance of this point can never be emphasized enough, that is, checking the patient’s details, like the spelling of their name, date of birth, and other information that are easy to overlook. A simple mistake in the patient’s demographic would mean the practice is heading toward claim rejection or denial. https://www.247medicalbillingservices.com info@247medicalbillingservices.com https://www.247medicalbillingservices.com info@247medicalbillingservices.com

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On-Time Claim

A standard procedure, process, and metrics for submitting the claim in a given time frame must be used to ensure no claim delays. As a practice, you must be aware of the claim deadlines, and the insurance companies provide a time limit to submit the claims. When you meet the deadline, the chances of claim denials are less, and even if a claim is denied, you have the time to re-check and resubmit, decreasing the chances of revenue loss.

• Correct coding

Payers can sometimes deny claims because the codes need to be more specific. The insurance companies not only require as much information as you can provide them about the service but also justify that the codes used are correct for the procedures. It is vital that orthopedic billing and coding are compliant with the new ICD-10 coding regulations and standards.

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