A New York orthopedic surgery practice often faces medical billing challenges due to the complexity and volume of its procedures, including joint replacements, spinal fusions, and arthroscopic surgeries for ligament repair. Unfortunately, the intricacy of these procedures can result in billing oversights and mistakes, leading to significant revenue losses that impact the practice’s financial stability.

Fortunately, orthopedic surgery practices can streamline their billing processes and safeguard their financial health by leveraging the expertise of a specialized medical billing partner like StarkBilling and implementing actionable tips. This article highlights common errors and provides practical strategies for optimizing the orthopedic surgery medical billing process.

Common Billing Errors in Orthopedic Surgery Leading to Revenue Losses

Orthopedic surgery billing can be stressful even for the most experienced in-house staff. Minor mistakes, including typos, can result in revenue losses for practices. Errors like incomplete documentation, incorrect CPT coding, and failure to verify insurance coverage can severely impact a practice’s financial health. Let’s discuss the most common billing errors that lead to revenue loss and the practical ways that your staff can bypass these problems and ensure a more efficient and accurate billing process.

Inaccurate Documentation

Inaccurate documentation is the primary culprit behind billing errors in orthopedic surgical practices. Proper documentation is essential for correct claim submission and compliance with payer requirements. Without it, practices can expect denied or delayed claims, significantly impacting revenue flow.

Common issues include missing operative reports, lack of detailed descriptions of procedures performed, and incomplete patient information. To avoid these problems, orthopedic practices should implement robust documentation protocols, provide regular staff training on accurate record-keeping, and utilize electronic health records systems that prompt necessary details. Ensuring thorough and precise documentation will facilitate smoother billing processes and enhance overall practice efficiency.

Incorrect Medical Coding

Incorrect medical coding is a frequent issue in orthopedic surgical billing. Unfortunately, it can lead to claim rejections and revenue losses if not caught early. Inaccurate coding can happen for several reasons, but it is often due to constant code updates and the challenging nature of orthopedic procedures like joint replacements, spinal fusions, and arthroscopic ligament repairs.

Using outdated codes, misinterpreting coding guidelines, or selecting the wrong code for a procedure can all result in errors. Practices should invest in regular employee training, employ certified medical coders, and utilize advanced coding software that automatically updates to reflect the latest coding changes.

No Follow-Up on Denied Claims

Working in orthopedics, especially surgery, can be challenging. Its high volume and stress make follow-up on denied claims particularly crucial.

Skipping out on timely follow-up can lead to serious issues, such as significant revenue loss. Denied claims typically result from procedures like joint replacements and spinal fusions, which require detailed documentation and careful coding.

Practices should establish a dedicated team or process for tracking and appealing denied claims. Implementing a plan to claim follow-up ensures that potential revenue is not lost due to oversight or administrative delays.

Lack of Staff Training

The lack of staff training is a significant challenge in orthopedic surgical billing. Acquiring high-quality in-house help can be difficult for any medical office, but for specialized care like orthopedics, they need to be particularly knowledgeable. The specialty requires a deep understanding of medical coding, documentation standards, and insurance policies specific to orthopedics and its various surgical procedures.

Without ongoing training, staff may struggle to keep up with coding updates, payer requirements, and compliance regulations, leading to billing mistakes and revenue loss. Undertrained employees increase the risk of errors, work slower, and divert time from more experienced billers who need to assist them.

Missed Insurance Verification

Missed insurance verification is a serious and ongoing issue for many practices. It’s typically due to the high costs and the complexity of the procedures. Doctors may perform surgery only to discover later that the patient’s insurance won’t cover it, leading to a denied claim. Orthopedic procedures like joint replacements and spinal surgeries often require prior authorization. Unfortunately, staff oversight in verifying coverage can result in non-payment.

In terms of avoiding these common mistakes, strategic planning and careful insight can only take you so far. Partnering with StarkBilling, a medical billing specialist, can ensure that your practice never loses revenue to billing errors.

Tips for Optimizing Orthopedic Surgery Billing with StarkBilling

Addressing billing errors is essential for any medical practice. Taking proactive steps to optimize your orthopedic surgical billing process can significantly affect your practice’s financial health.

StarkBilling specializes in helping New York orthopedic surgery practices tackle these issues head-on. It offers advanced billing software, claim follow-up and management, comprehensive insurance verification processes, and a clear understanding of payer contracts.

Let’s explore how partnering with StarkBilling can optimize your billing practices, streamline your billing operations, and help your practice get back on track.

1. Pick an Orthopedic Surgery Billing and Coding Expert

StarkBilling’s expert billing and coding team has years of knowledge, so they understand the specific challenges often experienced in orthopedic billing and coding. They are well-versed in the latest coding updates, payer requirements, and compliance regulations, ensuring accurate and efficient claim processing.

You can benefit from the specialized knowledge of an expert like StarkBilling, which will help your practice avoid common billing errors and improve its revenue cycle.

2. Use Advanced Billing Software

We understand that for many practices, making the jump to more advanced billing software can be intimidating due to the higher price tag. However, outdated software is sluggish and doesn’t meet the specific needs of modern orthopedic surgical practices.

StarkBilling’s state-of-the-art software reduces the risk of human error and ensures that claims are submitted accurately and on time. It’s regularly updated to reflect the latest coding and payer requirements, which helps prevent denials and delays. It also provides detailed analytics and reporting, so your practice is always in the loop.

3. Have Efficient Claim Follow-Up and Management

The StarkBilling team understands how crucial claim follow-up and management are for maintaining financial health. They ensure that every claim is followed up on quickly, always addressing denials and resubmissions so your practice avoids loss. By handling the headaches of claim management, StarkBilling helps your staff minimize the time and effort spent on administrative tasks, enabling them to focus more on patient care.

4. Understand Payer Contracts

Understanding payer contracts can be an invaluable skill, especially in orthopedic surgical practices. Each payer has its own set of rules, reimbursement rates, and compliance requirements, which can leave any medical biller confused and stressed. Worst of all, misinterpreting these contracts can lead to underpayments, denied claims, and potential contract violations, significantly impacting your practice’s revenue.

StarkBilling can help your medical practice with this daunting task. It will ensure that your practice fully complies with all-payer requirements and that you’re maximizing your reimbursement rates.

Conclusion

Orthopedic surgical practices in New York face numerous challenges, from the complexity of procedures to the high volume of patients. Among these, billing stands out as particularly difficult, with a high potential for errors. Common mistakes, such as inaccurate documentation, incorrect coding, lack of follow-up on denied claims, and insufficient staff training, can significantly impact financial health. However, these errors can be avoided. With StarkBilling, practices can find a reliable solution to maintain their financial stability and optimize their billing processes.

Capture more revenue, and expand your New York surgical practice by partnering with a specialized medical billing team that has in-depth knowledge of the coding requirements for your diverse procedures. Schedule a free consultation now.