Managing orthopedic billing, submitting clean claims, and avoiding denials have been painstaking and challenging tasks since the beginning. As insurance companies try their best to limit their ways of being notified or their drawbacks, they put all the financial burden on the patient. Healthcare providers have been facing an increase in denial rate, and the payment system and the shift to the consumer have faced notable changes.
There has been a considerable difference in life-enhancing processes like joint replacement and joint pain solutions. The orthopedic practice has little role to play with the insurance payers who need more time to pay for the procedures. At the same time, you can’t always hold yourself responsible for outside forces. Let’s dive into the significant causes of orthopedic details and what can be reasons to treat them.
It is sufficient to say that orthopedic billing services involve complex coding and invites more challenges when submitting the claim for the first time or after denials. However, outsourcing the billing side to reliable orthopedic medical billing services can save revenue leakage.
Understanding the significant causes of revenue leakage in orthopedic billing
When doing the medical billing audit, you will come to know the challenges that hinder the way to generate considerable revenue. Three areas can be managed manually with the help of 70% of the providers who can lend a hand to streamline the process.
Prior authorization
Prior authorizations (PA) are ranked as the top administrative load providers face today, with 370 healthcare groups signing on to recently discuss the issue with a US House of Representatives Committee on Small Business. Although most PAs are eventually authorized, the procedure can be time-consuming as each filing frequently requires several follow-up calls, faxes, and appeals.
Once manual processes can now be carried out in real-time with little assistance from your staff thanks to an automated and AI-driven software solution that can integrate with your orthopedic EMR/EHR. These processes include: Determining whether a PA is necessary., If so, prepare the appropriate patient demographic and insurance information, medical diagnosis codes, and treatment plans.
Verifying the insurance verification and Eligibility verification
Insurance verifications and eligibility verification benefits are among the most notable areas where details need attention. There are areas with no chance of errors, requiring a more indoor approach. This leads to claims denials and the work if there occur details. If you choose to do the accurate and verified start, you can handle the claims denials and promote the smooth flow of revenue cycle management.
Denial Management
Denial management is another process that requires more energy and time to cope with and correct the significant causes of denial. For instance, if you face denials, instead of getting demotivated and worrying about leaving them in the pipeline and waiting in the huge bundle of the denial, you should instantly correct all the major mistakes and resubmit the claims as soon as possible.
Also, using Artificial intelligence eight is how to be reimbursed on time and automate the most repeated task. Doing this will help you to overcome the significant problems related to coding errors, as artificial intelligence is the way to solve the problem and cope with those challenges where there is more need for manpower. Furthermore, using Artificial intelligence will help you manage most of your work and help you save your data for future reference.
- Analyzing and forecasting collectible dollars and timelines for recovery
- Predicting the next best course of action for each denial based on predictive analysis
- Resubmitting EOBs and checking the status and accuracy of EOBs in an integrated system
- Identifying root causes and solutions to prevent revenue leakage in the future
- Providing utmost accuracy and transparency through real-time operation analytics
If you handle the orthopedic denials manually, it will cost you more money. According to estimation, 60% of the denied claims occur due to needing the first recoverable on submitting the first claim. But If you choose to manage the denied claims via Artificial intelligence and resubmit denied claims without any sort of delay, you are going to claim a reimbursement in an easy way.
Payment posting
There are many ways to make your payment posting secure and safe. First, keeping your payment posting as safe as all the transaction records is essential. This will help you update all the forms of your expenses.
Secondly, follow up with your insurance company or third-party payors if you are afraid to face a delay in payments.
Outsource the billing task to orthopedic medical billing services
Hiring third-party billing companies who have favorable ratings and offer orthopedic medical billing services is an excellent strategy. When you consider outsourcing the admin task, choosing the specialty base orthopedic billing services would be more suitable. Further, following the above-mentioned strategies can generate more revenue and reduce the denials rate.