February 4, 2023

Healthke

All about your health

What are the common orthopedic billing errors

4 min read
Portiva

Portiva

Muscles, bones, ligaments, joints, and tendons are all part of the musculoskeletal system, and injuries to any of these structures are the focus of orthopedics. Due to the specialized nature of orthopedic care, orthopedic medical billing necessitates a more in-depth understanding of the providers’ offerings. It has also been highlighted that claims involving orthopedic surgery account for about 35% of all claims with an error rate of 25%. Unfortunately, not all of them are submitted again. There are a lot of pricey services in this sector, thus an increase in the rejection rate could have a major impact on earnings. To this end, it is crucial to get insight into the obstacles and strategies for overcoming them.

A number of external causes had significant impacts on the orthopedic medical billing industry

The changes and updates to the CPT (Current Procedural Terminology) Manual that went into effect in 2013 had a significant impact on orthopedic billing services reimbursement. In total, there were 500 changes to the Category I codes, making the coding much more complicated.

There are now more ways to categorize data from studies of nerve conduction. Two sets are needed for spine fusion and revision of the shoulder and elbow.

It is possible for incorrect coding to occur due to the presence of multiple types of personal injury liens, payers, and worker compensations. It may also cause more claims to be denied and submissions to be delayed.

Due to an increase in practice costs, there have been fluctuations in cash flow.

Problems with Orthopedic Billing Services and How to Fix Them

Coding Errors

Coders risk losing money or having claims denied since there are multiple codes for fractures and other injuries. If a patient undergoes many surgical procedures to address different types of fractures, each of those surgeries must be categorized as a “first encounter.”

Although correctness is of the utmost importance, human error in coding cannot be ruled out. Regular audits are your best bet. Bad unbundling practices, blunders, and excessive use of code may be uncovered.

Altering to ICD-10’s New Standards

With the transition to ICD-10, many small practices found it difficult to keep up with demands and stay profitable. However, there are significant differences between the old and new systems that every doctor should be aware of. Whereas ICD-9 didn’t address laterality, the new code sets require doctors to record information about illnesses, including joint problems and fractures, in terms of left, right, or bilateral.

It is now required that patients record the targeted body part(s) for any medical procedures. Claims may be rejected if necessary information is missing.

Now more than ever, orthopedic clinics require proof of where their patients were hurt.

The type of patient interaction, such as “original,” “subsequent,” or “sequela,” must also be included.

Exact and Detailed Recording and Verification

Before beginning treatment, it is important to double-check the patient’s details and insurance. It is now more important than ever to take precautions, as COVID-19 has resulted in a number of shifts in insurance policies and coverage. Each service a patient receives needs to be thoroughly documented by the billing department and then charged accordingly.

Documentation before, during, and after an orthopedic appointment is essential for billing purposes. There is no way around including modifiers and add-ons for reimbursement purposes. Similarly, doctors can improve their odds of precision by learning and employing fundamental coding phrases rather than tales.

Observing New Regulations

Patient contacts and treatments are coded using the Current Procedural Terminology (CPT) system. so it’s important to keep up. For instance, if internal or external fixation isn’t already a standard element of the method, you can’t code it.

Billing can be further complicated by the recent uptick in medical gadget use. Manufacturer recommendations have their uses, but Medicare regulations are always the best bet. Code medical devices with confidence by independently verifying their compliance with FDA regulations.

Compensation Payouts

A 1.5% annual drop in reimbursements has been observed, according to the research. Lack of familiarity with the intricate criteria each insurance provider uses to evaluate a claim is one potential source of error. Accuracy can be attained by employing cutting-edge tools and ensuring that all employees are up to date on any relevant policy changes.

Resubmitting claims while keeping an eye out for the most prevalent causes of denials is a wonderful way to boost payments.

At the end of the day, you need to keep your practice profitable and push for higher reimbursement rates for doctors. Correct orthopedic billing and coding services for claim documentation can increase payment.

There are a lot of hassles that can be avoided when outsourcing orthopedic billing services to an offshore medical billing company. Info Hub Services can take care of all your orthopedic medical billing needs, including timely filings, regular audit checks, follow-ups with payers, and re-submissions if necessary. Helping you keep your revenue cycle in order and prevent income loss is our top priority (RCM).