5 Best Practices for Improving Orthopedic Billing

Orthopedic surgeons work to keep people on their feet, but orthopedic billing can keep practice staff on their toes. From scheduling complex procedures to documenting visits and submitting claims, the orthopedic medical billing process can be difficult to standardize, especially when prior authorization requirements and orthopedic-specific coding rules create delays or denials. The good news is that a few repeatable best practices can help make billing more manageable, predictable and efficient.

To streamline and improve your orthopedic billing process, consider these five best practices.

1. Leverage Technology and Orthopedics-Specific Billing Software

Billing platforms designed for orthopedics can help support accurate coding for procedures, global surgical periods and multiple coding modifiers and align documentation with payer requirements. This templated approach can help make submissions more consistent.¹

2. Strengthen Prior Authorization Workflows Before the Date of Service

Check patient insurance information for prior authorization requirements before any procedures. For returning patients, confirm that there haven’t been any changes to their insurance. To minimize delays, verify benefits at scheduling and again ahead of surgery, use procedure-based authorization checklists and route requests through a centralized work queue with clear ownership. Establish a payer portal follow-up cadence so pending requests are monitored consistently until determination.

3. Keep Up With Coding Changes and Refresh Orthopedic-Specific Training

Continuously train staff on coding and billing updates. The AAOS is one potential source of educational content for practice staff.² To make training more effective, prioritize orthopedic drivers of denials, including modifiers, bundled services, global package rules and documentation requirements for high-volume procedures. Consider quarterly refreshers and denial trend reviews by payer and reason code to guide what to reinforce next.

4. Tighten Submissions and Standardize Appeals

Clean claims and timely follow-up can reduce payment delays and rework. Implement a clean-claim checklist that confirms required documentation, correct coding and modifiers, authorization status and accurate patient and coverage information. When denials occur, categorize them by reason, use standardized appeal templates with required attachments and set internal turnaround expectations. Tracking basic metrics like denial rate and days in A/R can help practices spot issues early and measure progress.

5. Offer Digital, Contactless Patient Financing Options as Part of a Patient Responsibility Strategy

Optimize the patient payment experience by offering a variety of payment options, including digital, contactless payment methods. Patient financing options like the CareCredit health and wellness credit card can help patients get the care they want and need when they need it while managing cost. Integrating financing into patient responsibility workflows, such as pre-service estimates and point-of-service payment conversations, may also help reduce outstanding balances and collection burden.

What Role Does Patient Financing Play in Orthopedic Billing?

Patient financing can play an important role in orthopedic billing by helping patients bridge the gap between a provider’s recommended treatment and their budget. Elective orthopedic procedures or treatment for acute injuries may generate high out-of-pocket expenses. According to Synchrony’s Lifetime of Healthcare Costs Research study, 1 in 4 Americans surveyed delayed recommended healthcare procedures because of cost.³

A dedicated financing solution like CareCredit can allow patients to spread payment over time, reducing financial concerns about getting the care they need. From a billing perspective, patient financing can also help support practice collections. Practices enrolled with CareCredit receive full payment quickly, typically within two business days.* This can mean fewer outstanding patient balances and less staff time spent on internal collection efforts.

Improving Orthopedic Billing, Step by Step

Orthopedic billing success depends on a sound, consistent process. By strengthening prior authorization practices, supporting orthopedic-specific coding accuracy, tightening clean-claim and appeals workflows and offering patient financing options, orthopedic practices may improve timely collections while supporting a positive patient experience. Continually refining billing operations may also free up more staff time to support excellent orthopedic care for patients.

Offer Flexible Financing at Your Practice

If you are looking for a way to connect your patients with flexible financing that empowers them to pay for the care they want and need, consider offering the CareCredit credit card as a financing solution. CareCredit allows cardholders to pay for out-of-pocket health and wellness expenses over time while helping enhance the payments process for your practice or business.

When you accept CareCredit, patients can see if they prequalify with no impact to their credit score, and those who apply, if approved, can take advantage of special financing on qualifying purchases.* Additionally, you will be paid directly within two business days.

Learn more about the CareCredit credit card as a financing solution or start the provider enrollment process by filling out this form.

Author Bio

Natalie Burg is a writer, editor and editorial project manager with 20 years of experience. She uses her expertise from a range of industries, including economic development, business, sustainability and more, to create content that educates and engages readers.

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