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Our services are tailored to meet the unique billing needs for orthopedic surgeries, joint replacement surgery, arthroscopic surgery, fracture repair, spinal surgery, osteotomy, and more. We cover end-to-end billing for these services, including coding and billing to electronic claims processing and payment processing. Our services comply with various regulations such as HIPAA and coding mandates set by AMA and AAPC. Here are the steps we follow to streamline your billing service:
- Integrate digital tools such as EDI, EHR, EMR, and PCS with orthopedic billing technology ecosystem to obtain real-time patient data for seamless electronic claims processing.
- Verify the patient's insurance coverage (provider information, registration numbers, effective dates, expiration dates, provider address, etc.) before scheduling the appointment.
- Fulfill pre-authorization needs from insurance payers before the orthopedic practice starts attending patients. This step is crucial to avoid any payment and reimbursement-related confusions after the medical procedure is done.
- Conduct real-time claims scrubbing to ensure billing codes accuracy (10021-69990 CPT code range, ICD-10, HCPCS Level II Codes, DRG codes, Evaluation and Management (E/M) Codes, revenue codes, and others).
- Submit clean claims to insurance payers such as government programs (Medicare, Medicaid), private insurance companies (Aetna, Anthem, Humana), Workers' Compensation, Tricare, Veterans Affairs (VA), Self-Pay, etc.
- Adhere to pertinent regulatory guidelines while handling various billing models, including value-based payment, fee-for-service, capitation, episode of care, telehealth etc.
- Perform a comprehensive claims review by analyzing Explanation of Benefits (EOBs), identifying reasons for denials, resolving any disputes, and initiating the appeals process when necessary.
- Analyze EOBs to calculate and report out-of-pocket expenses such as deductibles, copayments, and coinsurance to avoid any unbilled payments from the patients.
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