Most Common Orthopedic Medical Billing Denials to Consider

Denies have the power to ruin your company! Since orthopedic medical billing might abruptly derail your revenue cycle process, it requires more effort and attention. The billing method for orthopedic operations is one of the most crucial facets of a healthcare professional’s employment. In order to minimize stress levels and solve revenue payment issues, accurate coding and billing procedures must prevent billing delays and rejections.

Where one searches for answers is in the rejections report, where stress points inside the system are obvious if one looks at the details. According to the Medical Group Management Association (MGMA), 50 to 60 percent of all denials go unresolved until they are written off as bad debts. This shows that the rejections report, a potential source for operational improvement, isn’t getting enough attention.

Avoiding the 3 Types of Orthopedic Medical Billing Denials

Orthopedic practices normally see three types of rejection, each of which identifies possible areas for treatment improvement. By identifying the precise locations where these problems arise, your practice will have the ability to make significant advancements that have a direct influence on the bottom line.

  1. Clinical Denials:
  • Medical Necessity
  • Length of stay for hospital visits
  • The number of follow-up visits not adhered to
  • Level of care determination
  1. Administrative Denials:
  • Not a covered service
  • Untimely filing
  • Requests for medical records
  • Missing information
  • Itemized bills
  • Coding clarification – invalid, inaccurate, or missing codes
  • Bundling
  1. Omission Denials:
    1. Registration or demographic inaccuracies
    2. Missing or incorrect prior authorizations
    3. Insurance ineligibility

Are there any options for dealing with Orthopedic Medical Billing?

Having discovered where your rejected claims are coming from, the goal is to find feasible solutions that can improve the practice’s first claim submissions and recover reimbursement. It is usually necessary to work backward from the initial pain point to the operational solution.

The most obvious answer is to examine the first technique for producing your claims. Is it productive? Is it possible to improve it through automation? Let’s look at three areas that might require some work:

Prior Permission

The lack or insufficiency of Orthopedic Medical Billing prior authorizations (PAs) is a significant factor in claim denials. This usually occurs as a result of patients arriving at your orthopedic office without PAs from the referring physician and without obtaining PAs prior to beginning treatment.

Rather than searching out the relevant documents, why not utilize a sophisticated automation system that employs artificial intelligence (AI) to determine if a PA is required, process and submit the necessary information to the payer, and then provide 24/7 monitoring and follow-up? In this case, technologically enabled service solutions may complete PAs that formerly took hours or days in a matter of minutes, saving hours of administrative effort and time.

Insurance Verification and Benefits of Eligibility

It is permissible to gather demographic data either physically or digitally. However, once the data is accessible, digital verification and benefit eligibility are critical for managing the patient access procedure properly. Verifying this information online prior to each conversation reduces the number of denials for this issue dramatically.

Furthermore, because you are utilizing exact and up-to-date data, it is simpler to collect the patient part at the time of service (or earlier).

Few pointers to reduce the risk of Orthopedic Medical Billing denials:

  • The coding and billing staff of in-house billing processes must be aware of and up to date on the latest code changes.
  • To lower the chance of an Orthopedic Medical Billing denial, coders must be aware of the investment required for upgrades or revisions.
  • It is also critical to be aware of the most prevalent denials, as described above. Duplicate claims are one of the most common causes of denials and rejections. Another explanation is if the charge exceeds the fee schedule.
  • Ensure that all patient information is collected, and correct verification, cautious in acquiring proper insurance information, and never overlook insurance verification. Begin using an automatic billing service.
  • Understand how ICD-10 changes influence orthopedic billing and coding methods so that healthcare providers may remain vigilant.
  • ICD-10 changes and coding upgrades often touch all specialties but significantly impact orthopedic billing and coding services.
  • Newly released ICD-10-CM includes 143 updated codes with 51 deletions and 279 additions. Therefore, Orthopedic Medical Billing specialists must begin using these codes as soon as feasible.
  • The location of incidence is especially important in ICD-10 code revisions, which need more detail from orthopedic coding standards. Insurance companies will need injury documentation.

How does NEO MD Works?

You may expand your practice with the assistance of our professional team of medical billers and coders. To ensure adequate reimbursement, our staff strictly follows all CMS Orthopedic Billing guidelines. The probability of claim denial and refusal is lowered by coding each claim in real-time, promptly, precisely, and without errors, as well as completing an early review to confirm claim eligibility. In the United States, leading revenue cycle management organizations manage many newly constructed healthcare facilities.

By collaborating with reliable Medical Billing companies, your employees will be free to focus on practicing medicine and giving exceptional patient care. Our Urology Medical Billing services match the providers’ goals.  We’ve demonstrated our ability to develop plans, scale projects, and increase revenue for medical professionals across the country. Moreover, we offer Revenue Cycle Management services tailored to meet the specific needs of providers. Moreover, NEO MD provides its clients with free Medical Billing audits.

Orthopedic Medical Billing

What Makes NEO MD the Best Medical Billing Services Company?

NEO MD stood best among competitors due to ensuring the latest CMS Medical Billing and coding guidelines; 

  • Deliver customized Revenue Cycle Management Services to unearth operation shortcomings
  • Our experts work hard to reduce your front-end denials by 20%
  • Offer Provider & Staff Productivity Analysis
  • First level of Claim acceptance rate 95-98%
  • Improve RCM system efficiency with a robust credentialing team 
  • Provide fortnightly financial and practice overviews 
  • Refunds adjustment and Payment posting to improve the cash flow
  • Identify potential under, over, and incorrect coding scenarios
  • Out of Network Negotiations
  • Offer internal Medical Billing audits to uncover loopholes
  • Evolving state-of-the-art medical billing services for small practices
  • We have consistently increased the collection rate for our clients because of the faster increase in the accuracy of fees and collection
  • Provide Medical Billing and collection services that are of high quality and error-free

Let’s Schedule a Demo to learn more about how we can improve your medical practice management. Get us at! ( or (929) 502-3636).