Orthopedics is a branch of medicine that regularly sees a constant stream of patients and is ever busy. Running an orthopedic practice means that you should have the right balance of managing the business and working on your clinical expertise to actually succeed. Many orthopedic practitioners focus extensively on their clinical processes and not so much on the business, constantly struggling to break even or succeed financially. Orthopedic medical billing and coding is a service that helps regulate the business part of an orthopedic practice, clinic, or department, supporting the practice to improve its revenues and grow as a brand.

Why is it not a smart move for medical practitioners to handle billing and collections?

Now, if you run a small practice, you may be tempted to handle the medical billing and collections yourself. This also makes sense since you can save money spent on hiring an internal team or a third-party medical billing and coding team to help you out.

However, the problem is with balancing both the practice and the business. While doctors already face the risk of work burnout, asking them to also look into the business side of it is unfair. Unless a person is an expert handling billing and coding, they will not be able to justify the job.

A large healthcare provider may consider having an internal team to handle billing and coding instead of getting help from an RCM third-party company. This may work as long as the team is equipped to work independently and consists of people with the right experience and expertise.

We did talk about the pros and cons of having your own medical billing and coding team vs. hiring a third-party service provider some time back. Do check that out to know more.

Common challenges faced while billing and coding for an orthopedic practice

Recent surveys say that about 35% of orthopedic surgery claims are incorrect and 25% are rejected. With such a large rejection rate, no wonder most practices find it unable to be consistently profitable. Here are some of the challenges faced while handling medical billing and coding for an orthopedic practice.

1.   Complexities in coding – Orthopedic procedures, especially those done for accidents and physical trauma, can involve multiple procedures. That is why the coding part gets more complicated. There are multiple modifiers you have to use while coding for different procedures. For instance, when a patient receives a removable foot insert, using the modifier KX is necessary to prevent payer rejections. Many practices forget /don’t know about this and face reimbursement denials. Also, let’s assume a person comes with multiple fractures due to an injury and needs different surgical procedures. Medical billing and coding experts have to know that all the first procedures will have to be grouped as initial encounters.
2.   Billing challenges – Orthopedic billing greatly depends on the documentation collected from the minute the patient steps in to after discharge. The billing department has to work closely with the physicians, getting the right documents at every step. If your billing team is not clear about what is wanted, then there is a high chance the claim gets rejected, stating a lack of supportive documentation. Do note that this is the first step to actually recording all the procedures that were performed. If this is not done right, then overbilling/underbilling may occur.
3.   Constant changes with ICD-10 regulations – This is a challenge faced by the entire medical billing and coding, to be fair. There are constant changes in the ICD-10 regulations and keeping up with these changes themselves takes a considerable part of the time and effort put by a biller or a coder at work. Unless the coders and billers have the right skills, these changes will lead to increased rejection rates.