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Orthopedic Billing & Coding Services

Orthopedic surgery or Orthopedics is the branch of medicine dealing with the conditions of the Musculoskeletal system - the bones, joints, ligaments, tendons, and muscles that are so essential to movement and everyday life.

Orthopedic Billing & Coding Services

Complexities in Orthopedic Billing

Orthopedic billing depends on proper documentation before, during, and after a patient visit. The billing team needs to carefully document and charge for all Services provided. Errors like incomplete patient demographics entry or not prior- verifying the patient's eligibility could result in a rejected claim. In addition to authorization errors, not knowing insurer preferences and deadlines can also hamper revenue collection.

Compared to other specialties, orthopedic billing is complex and requires a deeper understanding of providers' Services. Nearly 35% of orthopedic surgery claims are incorrect, out of which 25% of medical claim gets rejected. Such high denial rates can lead to compromised revenue & patient care while bankrupting your orthopedic practice.

Although hiring an in-house billing team and properly training your team can help avoid severe fees and penalties, the orthopedic billing process is too complex to be sustained by an in-house team. One way to reduce stress on your staff and increase reimbursement is to outsource your billing & coding requirements to a technologically empowered billing company like RM Healthcare.

RM Healthcare orthopedic billing Services include regular audit checks, account analysis, and follow-up with payers. While working with us, you will receive regular reports detailing productivity, quality, and new revenue opportunities. RM Healthcare expert medical billing professionals use industry best practices and advanced software to meet orthopedic providers' billing needs.

Medical Billing & Coding Services Expertise in Orthopedics

At RM Healthcare, we have a client base that spans across all 50 states, covers a wide range of hospitals, physician practices (including orthopedic practices), and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA, and are certified by the American Academy of Professional Coders (AAPC). It would be fair to state that we have a decade of experience in orthopedic billing & coding.

Applying best practices for Orthopedic Billing & Coding Services

We understand the nuances involved in orthopedic medical billing, such as correctly bill pain pump insertions or plc reconstruction and arthroscopies. Our certified coders work with you 24/7 to prevent problems caused by incorrect use of modifiers, as well as educate your in-house billing specialist on how to avoid them. Our professional orthopedic billing experts work to prevent claim denials while increasing reimbursements. We do this by focusing on efficient, streamlined processes that decrease the amount of time needed to correctly bill orthopedic Services. We have built an approach anchored on modern technology and a team that focuses on providing data-driven solutions to reduce denials and increased revenue.

Our expertise in Orthopedics includes but is not limited to :

  • Foot and Ankle Surgery
  • Hip and Knee Surgery
  • Shoulder and Elbow Surgery
  • Trauma Surgery
  • General Orthopedics
  • Orthopedic Oncology
  • Spine Surgery
  • Bone Health Center
  • Hand Surgery
  • Pediatric Orthopedic Surgery
  • Sports Medicine
  • Osseointegration Clinic

Benefits of our Orthopedic Billing and Coding Services :

We bring excellence, knowledge, and accuracy to orthopedic billing and coding Services while building a revenue cycle devoid of defects for your practice. With patient demographics entry, insurance verification, insurance authorizations, coding, billing, and reconciling of accounts, our medical billing process can add value to your organization. Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process. We ensure consistent accounts receivable follow-up and prior authorization to avoid claim denials. Our claim denials management team's #1 priority is shifting your focus from denial management to denial prevention. RM Healthcare helps orthopedics offer excellent care for their patients, focusing on improving their administrative & financial excellence. We bring you a team of specialists who are:

  • Certified from The American Association of Professional Coders (AAPC),
  • Familiar with medical billing software such as Lytec, Medic, Misys, Medisoft, NextGen, and many more,
  • Trained in coding software such as EncoderPro, FLashcode, CodeLink, etc.,
  • Able to apply standard CPT, HCPCS procedure and supply codes, and ICD-CM diagnosis coding as per CMS guidelines,
  • Successful track-record of processing medical bills with leading commercial carriers such as United health, WellPoint, Aetna, Humana, HCSC, Blue Cross Group, etc.,
  • Able to negotiate successfully with Medicare and state-specific Medicaid policies.

Typically, our clients see revenue improvement of over 30% and denials reduction of a minimum of 10%. We achieve this by applying our expertise, process rigor and by employing an excellently trained team.


RM Healthcare handles more than 250,000 patient support calls each month