Orthopedic Billing Services for Orthopedic Practices
Orthopedic billing runs on global periods. A surgery pays for the procedure and the follow-up care together. A fracture comes with the first cast built in. And one patient can leave with an injection, a brace and an X-ray from a single visit. Then come prior authorizations for MRI and surgery, along with workers' comp and auto accident claims that follow different rules altogether. Small mistakes get expensive. We handle orthopedic billing so the global package, the modifiers and the payer paperwork all line up.
What trips up orthopedic claims
The usual trouble spots, from the OR to the cast room.
Global surgical periods
Procedures carry global periods of zero, ten or ninety days, and visits inside that window are usually part of the surgical payment. Modifiers 24, 25, 57, 58, 78 and 79 decide whether related or unrelated care can be billed on its own.
Fracture care and casting
Fracture and dislocation codes already include the first cast or splint and the follow-up care. Replacement casts, supplies and later services each follow their own rules, and they are easy to bill wrong.
Injections and guidance
Joint injections, drug codes and ultrasound guidance come with coverage limits and bundling edits. Drug units, laterality and the diagnosis behind the injection all have to match.
Modifiers on nearly every line
Bilateral, multiple procedure, assistant surgeon and laterality modifiers (50, 51, 80, 82, AS, RT, LT) change payment line by line, and payers do not all apply them the same way.
Braces, boots and supplies
Braces, boots, slings and other devices use HCPCS codes and payer-specific rules, and billing them often takes DMEPOS enrollment or supplier credentials. Documentation and proof of delivery count.
MRI and surgery approvals, workers' comp and auto
MRI and surgery often need prior authorization. Workers' comp, auto accident and attorney-handled cases bill on different forms and fee schedules than standard insurance.
How we support orthopedic practices
Take all of it, or pick the parts that hurt most.
Coverage and injury-claim checks
Coverage and referral rules get checked up front through eligibility verification, and we find out early when a visit belongs to a workers' comp or auto claim.
Approvals for imaging and surgery
MRI, procedure and surgery requests go out with the clinical packet and get followed through prior authorization. Approvals that are about to lapse get noticed.
Global-period coding
Our medical coding team reads the operative note and checks the procedure code, global period, modifiers and laterality.
Charges for procedures, injections and supplies
Every procedure, injection, cast and brace is entered through charge entry and matched to the schedule. Supplies are the usual thing that gets dropped, so we look for them.
Claims for every payer type
Standard claims, workers' comp and auto carriers all go out through our claim submission process on the correct forms.
Bundled and reduced payments
When we post payments, anything bundled or paid below expectation is flagged for review.
Global-period and modifier denials
Global period, modifier, authorization and medical necessity denials land with our A/R and denial team for follow-up.
Surgeon and facility enrollment
Surgeons, mid-level providers and facilities get enrolled through credentialing, with renewal dates tracked.
Reports that show the leaks
Your report lists A/R by payer type, denials by reason, and any procedure or supply that was never billed.
Your EHR and imaging software
We work in your EHR, imaging and billing software. Nobody on your staff has to learn a new system.
Getting an orthopedic practice started
Five steps, in the order they happen.
Look at your case mix
We review how much of your work is surgery, injections, fractures or therapy referrals, and which payers cover it.
Map global periods and payer rules
Global periods, authorization rules and injury-claim handling get written down for each payer.
Get access and a checklist
Secure system access goes in first, then a front desk checklist for injury-related visits.
Work the claims
Day to day, we handle verification, coding checks, claims, posting and follow-up on a schedule you have signed off on.
Check the results together
Global-period denials, A/R and unbilled supplies are reviewed with your team.
Braces and supplies
Bracing follows DME rules. See our DME billing services.
Approvals before surgery
MRI and surgery usually need approval first. Read about our prior authorization services.
Denied claims
See how our A/R and denial management team picks up what payers push back.
Let us look at your orthopedic claims
Global-period denials, modifier errors and slow approvals can tie up a lot of money. Tell us how your practice bills today, and we will go from there. A free billing audit is a sensible first step.
Get a Free Billing AuditCall (321) 788-3655Frequently Asked Questions
Questions from orthopedic practices.
1. How do you keep track of global periods?
We note the global period for each procedure and check related visits inside the window. Related care does not get billed on its own by mistake, and unrelated care gets the right modifier.
2. Do you bill fracture care and casting?
Yes. We follow each payer's rules for fracture care codes, casting and splinting supplies, and follow-up care.
3. Can you bill braces from our office?
Yes, if your practice is enrolled to supply them. We apply the HCPCS codes, documentation rules and payer requirements that go with each item.
4. What about workers' comp and auto accident claims?
We handle both. Each goes to a different payer on a different form and fee schedule, and we follow the rules for each one.
5. Who takes care of MRI and surgery authorizations?
We do. We find out what each payer requires, file the request and stay on it until it is approved.
Specialties that often overlap
Orthopedic patients tend to show up at these practices, too.
Physical Therapy Billing
The clinics that treat your post-op and injury patients.
Pain Management Billing
Spine injections and nerve blocks, with their own medical necessity rules.
DME Billing
Orders and proof of delivery for braces and other equipment.