MBC Charting the Impact of Orthopedic-Billing since Last 2 Years


Orthopedics as a specialty has registered an upward growth, and with it MBC billing experts too have been swamped by increased demand from US orthopedic surgeons and physicians. Due to this development MBC for the last couple of years; has been recording the impact of orthopedic billing to properly interpret all the dynamics involved in order to help clients better.

MBC experts have charted these specifics related to orthopedic growth-

  • Innovative care procedures for the specialty introduced
  • New technology breakthroughs in the orthopedic industry
  • New techniques bought in for anesthesia administration
  • Medicare reimbursement reforms continues to be pro-orthopedic

These factors combined together have largely been responsible for an increase in growth, also enabling a shift of orthopedic care from hospital-based inpatient form to; the more affordable outpatient or ambulatory settings. MBC research professionals’ findings reveal that presently the growth rate is 20% for this type of orthopedic care, at par with other fast growing specialties.

Impact of Orthopedic Billing– MBC experts believe that despite being upbeat about the growth, orthopedists are also cautious about the accompanying billing complexities. In addition there are various billing challenges and complexities intrinsic to the specialty, which can become more pronounced with the increased growth.

Orthopedic billing challenges-

  • Orthopedics uses a wide range of procedures to treat the various orthopedic conditions, which are interpreted and valued differently by the diverse payers
  • Extensive coding revisions in 2013 (500 code changes to the Category I codes, including 251 revisions, 151 new codes and 100 deletions)
  • The upcoming ICD-10 – increasing the number of codes along with making coding more complex and detailed
  • Every year CMS fee schedules for orthopedics are becoming progressively smaller
  • High degree of influence of technology on orthopedic billing; necessarily requires operational functions to be compliant with the requisite degree of automation in most cases
  • Insurance underpayments for orthopedics can range between as high as 10 to 15% of the actual claims; with a potential of reaching even 20%. As orthopedic procedures tend to be highly expensive; even a small percent of underpayment can lead to high revenue losses
  • Orthopedic patients billing deals with- high balances, complicated explanations from payers and physician invoices that patients do not easily understand, hence if not handled properly can easily lead to loss of revenue and unsatisfied patients

Besides this commercial carriers process orthopedic surgery claims erroneously 35% of the time, while greater than 25% of submitted claims get denied and 15% of such claims are not resubmitted for appeal. Most denials can be prevented; but orthopedists with a hectic schedule find it rather difficult to do much about the situation. Numerous orthopedic practices considering these variables have opted for specialized medical billing services.

How does MBC help with orthopedic billing?

After an in-depth study for the last 2 years of the various orthopedic billing services challenges– MBC to help clients better has been following systematic Revenue Cycle Management. The RCM includes comprehensive processes such as coding, charge posting, claims filing, payment posting, and A/R follow-up, denial management, and reporting. Additionally to accommodate the changing billing scenario MBC experts also –

  • Evaluate the orthopedic practice
  • Help physicians understand where to allocate resources in order to track finances accurately
  • Appropriately advice physicians on improving front end interaction and billing procedures

MBC orthopedic billers have the requisite knowledge to understand the rules surrounding payer-specific coverage policies, ICD and CPT codes, and post-operative modifiers. Considering the extensive orthopedic coding changes for 2013, MBC orthopedic experts have increased their focus on regularly updating themselves with industry changes and reforms.

With regular training and updates, MBC orthopedic billers can handle-

  • Intricate orthopedics billing codes and rules
  • Orthopedics-related terminology
  • Coding for surgical procedures
  • Code variations related to multiple procedure rules

 

Managing to attain improved AR rates; also reducing underpayment by 7-10%. 

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