Surgical episodes are where orthopedic revenue quietly disappears.
An orthopedic claim is rarely one line. Between global periods, implants, assistants and post operative visits, one episode can lose money in four places at once.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Orthopedics claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Implant charges left off the claim
High cost hardware has to be invoiced and coded to be paid. When the implant log and the claim disagree, the payer pays the claim.
- Assistant and co surgeon roles miscoded
Assistant at surgery and co surgeon carry different modifiers and different payment. Coded loosely, the second surgeon is not paid at all.
- Post operative visits billed inside the global
Everything inside the global period is bundled unless it is unrelated and documented as such. Most practices bill it anyway and absorb the denial.
What we bill for Orthopedics practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Orthopedics accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- An orthopedics coder, not a general one
The coder assigned to your account works orthopedics every day. They already know which of your payers do what, and they are watching global periods, implant invoicing and assistant at surgery modifiers.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in orthopedics it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your orthopedics claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Orthopedics practices
- Coders who work orthopedics daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Orthopedics billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Orthopedics service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Orthopedics practices ask
Do you handle workers compensation?
Yes. It runs on different rules, different forms and slower timelines, and we track it separately so it does not contaminate your commercial aging.
Who reconciles implant invoices?
We do, against the operative note and the vendor invoice, before the claim goes out.
Can you bill our in house therapy too?
Yes. Timed unit rules apply there and we treat it as its own line of work rather than an afterthought.
What about fracture care global periods?
Fracture care carries its own global period and it is a common source of bundled denials. We track it per episode.
Have an orthopedics coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.