Prime Doc Billing provides Orthopedics Revenue Cycle Management (RCM) services for orthopedic practices across all 50 U.S. states. Our RCM services include each step, from patient registration and charge capture to reimbursement and reporting.
Our orthopedic billing specialists manage medical billing, claims processing, denial management, payment posting, and accounts receivable follow-up to optimize financial performance, increase revenue collection, reduce claim denials, accelerate reimbursements, and improve cash flow for plastic surgery providers.
Our Specialties
Every stage of the orthopedic revenue cycle (Ortho RCM) is included in our revenue cycle management services. Some of the most demanding orthopedic RCM stages that Prime Doc Billing serves, include:
Prime Doc Billing provides payer enrollment and credentialing services to orthopedic providers to ensure uninterrupted patient care and reimbursements for musculoskeletal services. We manage CAHQ profiles, NPI validation, and payer contracting for orthopedic surgeons and group practices, while ensuring participation with Medicare, Medicaid, workers’ compensation networks, and all the major commercial insurers.
We perform orthopedic-specific insurance verification, benefits coordination, cost estimation and eligibility checks for high-value procedures like fracture care, joint replacement, imaging, auto injury and workers’ compensation cases. Our insurance verification team further investigates patient’s out-of-pocket costs for procedures like arthroscopy and spinal injections, to help reduce financial surprises for the patients.
We secure timely prior authorizations and referral coordination for high-cost procedures like arthroscopic meniscus repair, ACL reconstruction, spinal fusion, and joint arthroplasty to reduce treatment delays for orthopedic patients. Our RCM team manages orthopedic referrals for MRI, CT scans, and physical therapy while aligning with the payer-specific guidelines.
Our certified medical coding experts ensure accurate CPT, ICD-10, and HCPCS coding for orthopedic E/M visits, global fracture care, surgical bundles, implant usage reporting, and modifier application. We regularly conduct orthopedic coding audits to ensure compliance with NCCI edits, global surgical packages, and payer-specific orthopedic billing guidelines.
We ensure accurate clinical documentation and medical necessity validation for operative reports, SOAP notes, fracture classifications, range-of-motion assessments, and medical necessity justification for multiple orthopedic procedures, like decompression, arthroplasty, and spinal instrumentation.
Our RCM experts ensure the orthopedic clinical documentation accurately reflects the severity of injury, functional impairment, and previously failed treatments for maximum reimbursements.
Prime Doc Billing provides end-to-end medical billing and revenue cycle management for orthopedics procedures including charge capture, claim scrubbing, UB-04 and CMS-1500 submission, surgical global period billing, implant and device billing, and reconciliation of orthopedic procedural reimbursements.
We perform real-time claim tracking to ensure cleaner claim submissions, while minimizing claim rejections for high-cost orthopedic surgeries.
We proactively follow-up on aged AR claims and resolve underpayments for orthopedic procedures to ensure maximum payment collections for high-value procedures like, total joint replacement and spine surgeries. Our AR specialists analyze denial patterns to identify recurring underpayments and prevent revenue leakage in orthopedic claims.
Prime Doc Billing provides comprehensive denial management services for orthopedic claims and sends timely appeals by attaching operative notes, imaging reports, and medical necessity documentations for procedures like rotator cuff repair and spinal decompression.
We identify root cause analysis for recurring denials related to authorization gaps, coding mismatches, and documentation insufficiencies and implement preventive strategies to reduce orthopedic related claim rejections.
Prime Doc Billing provides practice management services for orthopedic practices by streamlining end-to-end clinical and administrative workflows, including appointment scheduling, patient flow coordination, surgery scheduling support, documentation standardization, charge capture accuracy, and revenue cycle alignment to improve operational efficiency and maximize reimbursements.
We follow-up on the performance dashboard to monitor case volume, turnaround times, and surgical utilization efficiency for continuous operational improvement of orthopedic practices.
Our remote virtual assistants help orthopedic clinics with scheduling trauma cases, managing follow-up visits for post-surgical patients, coordinating DME (Durable Medical Equipment) orders like braces and orthotics, and handling patient communication for postoperative rehabilitation plans.
We assist orthopedic clinics with medical records management, patient reminders, and coordination of imaging and therapy appointments to improve orthopedic care for patients and providers.
Prime Doc Billing provides revenue cycle management services for all the medically necessary orthopedic procedures, some of which includes:
Choosing to outsource RCM services to specialized billing teams help healthcare providers get access to experienced billing professionals and scalable solutions to enhance revenue cycle efficiency of the practice. Outsourcing Orthopedic Revenue Cycle Management helps practices streamline complex challenges associated with financial and administrative processes, including highly detailed coding structures, global surgical packages, implant reporting, laterality modifiers, and multi-stage procedures, like joint replacements, fracture repairs, and spinal surgeries.
Outsourcing significantly improves orthopedic claim processing by ensuring timely prior authorizations, verifying medical necessity requirements, and attaching accurate documentations before claim submission. Outsourced RCM specialists handle billing for high-value orthopedic procedures, like expensive implants, and operating room utilization to reduce claim rejections and underpayments for orthopedic practices.
Additionally, outsourcing has proven to be a cost-effective option for orthopedic practices, while reducing the administrative burden from orthopedic physicians and in-house staff. The expert RCM teams allow orthopedic providers to focus more on patient care, surgical precision, and clinical outcomes, while they handle the practice’s time-consuming billing tasks.
You should choose Prime Doc Billing for outsourcing orthopedic RCM services because of our in-depth understanding of orthopedic billing complexities, including fracture care global periods, joint replacement bundles, spine procedure coding, implant billing, and modifier usage for surgical precision. Our experienced RCM team includes orthopedic billing specialists, certified medical coders, and revenue cycle experts who are well-versed in:
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(347) 650-2656
(347) 650-2656
info@primedocbilling.com
