Medical Billing

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orthopedic medical billing

Proven Strategies To Succeed At Orthopedic Medical Billing

Every healthcare department is unique from one another. Entire healthcare is divided into multiple departments based on the treatments and disease. But one thing that keeps it united is medical billing. Though the health services might differ, there is the same billing process in each sector. So by keeping this unity and departmental knowledge in mind, here we will dive into orthopedic medical billing.

Orthopedics deals with bone and muscle-related issues. Since an adult body contains 206 bones, any of these might show abnormality in the span of your life. So orthopedic doctors are here to solve your problem and keep your bone and structure fit.

Now let’s have a look at this specific field of healthcare billing and learn about the strategies that will guarantee maximized revenue.

Understanding Orthopedic Department

orthopedic picture of a bone

Bones and muscles are an essential part of the body. It requires constant attention to keep it in use and don’t get any aches. But if it happens, the orthopedic department is here to save the day. If you feel any unusual pain in your skeleton, you must consult these. 

However, we are not doctors to prescribe you the treatments for your disease. Instead, here we will see the structure upon which this orthopedic department stands. Let’s have a look at the essential components of orthopedic medical billing.

Healthcare Professionals

Following are the professionals you will find working in this department:

Surgeons: They perform surgical operations on a patient to treat orthopedic conditions like bone fractures and joint replacement.

Nurses: They make up an essential part of the medical treatments, providing constant pre-operative and post-operative care to the patients. They also keep them updated about their health.

Therapists: They are closely collaborated with orthopedic doctors. They perform regular exercises on the paralyzed or broken bones of the body to make it work again.

Administrative staff: These are the people who manage patients’ schedules, appointments, and treatments. Administration is also involved in orthopedic medical billing and coding procedures.


Healthcare staff of the department perform their respective functions with the help of the following facilities:

Examination room: It’s more like a clinic where the doctor will go through your injured body part and diagnose the problem and its treatment.

Imaging center: For internal examination, imaging rooms are used, where machines like X-ray, CT-scan, and MRI scanners are available.

Operating theater: As the name indicates, it is where the final show happens. Doctors will give you the treatment in this room equipped with advanced machinery, lights, and medical supplies.

Common Orthopedic Medical Billing Terms

person holding a bill

Before moving on to an action plan to optimize your orthopedic medical billing and secure more revenue, you must be aware of some terms. These definitions will come in handy because billing and coding are all about this. So read these and memorize them in your head.

CPT Code (Current Procedural Terminology)

A five-digit number that represents medical treatments and services that healthcare professionals provide. 

ICD-10 Code (International Classification of Diseases, 10th Revision)

An alphanumeric code that’s used to report and categorize symptoms and diagnoses. ICD-10 codes for orthopedics include a wide range of illnesses, including sprains, fractures, arthritis, and other musculoskeletal conditions.


A two-digit code that is added to a CPT or HCPCS (Healthcare Common Procedure Coding System) code to provide more details about the procedure or service that was carried out. 

CMS (Centers for Medicare & Medicaid Services)

The federal organization in charge of running the Medicaid and Medicare programs. Following these rules and guidelines is necessary when it comes to orthopedic medical billing.

RVU (Relative Value Unit)

A metric used by payers like Medicare to calculate the relative resource intensity of a medical service or procedure and determine its reimbursement rates.

E/M Code (Evaluation and Management)

CPT codes are used to report services provided during patient encounters, such as office visits, consultations, and hospital admissions. Orthopedic practices use E/M codes to bill for evaluation and management services, including initial consultations and follow-up visits.

Denial Management

The procedure for locating and addressing insurance payer claim denials


An outside service provider who, on behalf of healthcare providers, handles and submits electronic claims to insurance payers.

Fee Schedule

This is a list of set rates at which insurance payers have agreed to reimburse medical services and procedures. 

Proven Strategies For Billing Success

meeting of people

When conducting billing and coding, having a plan is essential because it keeps all the tasks aligned. Even after having a strategy, some tips can enhance your orthopedic medical billing and increase the chances of securing ample revenue. Neglecting these approaches won’t hurt anything, but waste your efforts in the exhausting processes. So why not put your efforts in the right place?

Stay Informed Of The Updates

Changing healthcare regulations and coding updates is the biggest concern. You must keep an eye on upcoming and deleted codes to use accurate codes in your bill. This ensures quick claim approval. 

Also, the regulations might put you in danger if you don’t comply. So knowing what healthcare authorities want you to do is the key to doing the right thing.

Leverage Technology For Claim

Manually conducting orthopedic medical billing is good until you get multiple claim denials. The reason? Manual error. As a responsible healthcare staff, implement and utilize updated software and systems. Automation is another great idea. This will speed up your process and eliminate all potential errors that lead to claim denials.

Using tech is just like preparing accurate claims that an insurance company loves.

Implement Pre-Authorization Protocols

Instead of wasting time collecting patient’s information, just set up a clear system to authorize patients before the treatment. This includes contacting insurance companies early on to make sure a patient is eligible.

Also, for high-cost treatments, educate the patient about their anticipated bill and other out-of-pocket expenses. This way they will be prepared for the payments or if they are not in the condition to make the payments, they will ask for the payment plan.

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    Foster Communication And Collaboration

    When you are working towards such an intricate process, clear communication will make it easy to achieve your goals. You must eliminate barriers that make it difficult for your staff to ask for assistance and work together. You should conduct regular meetings to keep everyone on the same page.

    When your staff is united and motivated, they will perform at their best and it will bring fruitful results.

    Orthopedic Billing Mastery

    Medical billing is a complex process. But with a little knowledge and success strategies you will win the process. So instead of wasting your efforts on outdated processes, implement orthopedic medical billing the new way and guarantee your revenue.

    Here we have also created your background in the orthopedic department, it will assist in performing accurate billing and coding and your healthcare facility will receive more revenue than it spends.

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