Top 4 Medical Billing and Orthopedic Coding Challenges Faced by Practitioners in the United States

Medical billing and coding in the United States remains on the rise, while orthopedic practices continue growing steadily with its associated billing and coding problems which, in turn, impact the practice's revenue as well as their operations. Indeed, the industry will grow by about 10% over the next ten years. A practitioner, whether in a private or consolidated orthopedic practice, is focused not only on patient care but also on the back-end tasks that ensure your practice runs smoothly.

However, there are certain problems with handling billing internally or outsourcing to a medical billing and coding company. There are many denied and rejected claims due to some common errors that could be easily avoided, which results in lost revenue. Addressing these challenges will enable your practice to greatly improve the billing process and maximize profitability. Here are the top four challenges orthopedic practices face and how you can overcome them. These also emphasize the Importance of accurate coding and billing in Orthopedics.

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1. Handling Prior Authorizations

The other main bottleneck in orthopedic practices is handling prior authorizations. An AMA survey shows that healthcare providers have to spend an average of 16 hours per week simply in getting prior authorizations. In orthopedic practices, it is as high as 30 hours. This delay in getting an approval can lead to patients having to wait for extended periods, which may cause loss of business.

Many practices cannot cope up with the volume of prior authorizations, causing treatment delay and frustration in the patients. With this system, you can remove those inefficiencies. Tools such as QuintAna help O P O to automate the prior authorization, resulting in significantly reduced delays and, therefore, improving patient satisfaction.

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2. Complexity in Surgical and Diagnostic Coding

Orthopedic coding can be very complex, especially with the constant updates of the ICD coding system. The transition from ICD-10 to ICD-11, which is expected by 2025, means that medical coders must stay current and adapt quickly. Small errors, such as using modifiers incorrectly or missing updates, can lead to denied claims.

Orthopedic practices face different dilemmas like bundling mistakes, NCCI edits and medical necessity documentation. It may happen in a bill where it involves the provision of joint injections and forgetting the correct modifier like 59 or 25 leads to a rejection on claims.

Automated coding applications such as Codessence avoid committing these errors. Through the processes of machine learning and the back-end edits, potential errors are picked out for a claim before its submission ensures reduced denial and the payment cycle accelerates.

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3. Inefficient Denial Handling Management

Most orthopedic practice units take high rates of denials without querying these denials. National denial averages in U.S. hospitals stand at between 6% and 13%, and many practice units accept much higher levels. For instance, 20% means that one in five claim denials.

This inefficiency can hurt revenue very significantly, as practices must spend more time and money to appeal denied claims. By partnering with O P O, you can initiate more proactive strategies to cut the denial rate, optimize the RCM, and improve cash flow by bettering claim management practices.

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4. The Challenge of Doing It All In-House

For small or medium-sized orthopedic practices, it may seem more economical to handle medical billing and coding in-house. However, this approach can quickly lead to inefficiencies, especially if your practice does not have a steady stream of billing and coding work. Hiring and maintaining a qualified internal team can also be costly and time-consuming.

Outsourcing your billing and coding to an expert company like O P O can be a game changer. Whether you're looking to reduce overhead costs or free up valuable time, outsourcing ensures that your billing processes are in the hands of experts who can streamline operations and reduce errors.

Conclusion: Strategies for Error-Free Billing and Coding

The challenges that orthopedic practices face in billing and coding are real but not insurmountable. With the use of automated solutions and partnering with a trusted medical billing and coding provider like O P O, you can improve the accuracy of your coding, reduce claim denials, and ensure timely payments.

Avoid having inefficiencies cause slowdowns in your practice. The role of outsourcing in Orthopedic Billing today is uneuqestionable. Contact O P O today and learn how our leading-edge RCM solutions will streamline your billing and coding processes, improve patient satisfaction, and drive better revenue outcomes for your orthopedic practice.

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