Top Ways to Streamline Coding and Denial Management Workflows in Orthopedic Billing
The Centers for Medicare & Medicaid Services (CMS) has clearly set policies and reimbursement rates for providers and follows the Physician Fee Schedule guidelines to streamline the billing process. Medical billing and coding for orthopedic surgeries have very similar guidelines.
The Centers for Medicare & Medicaid Services (CMS) has clearly set policies and reimbursement rates for providers and follows the Physician Fee Schedule guidelines to streamline the billing process. Medical billing and coding for orthopedic surgeries have very similar guidelines. However, the global pandemic has had adverse effects on the medical billing reimbursements for orthopedic surgeries.
For instance, consider that the federal COVID-19 relief packages could have a significant impact on the additional cuts, while leaving lower margins for small practices and physicians. While reimbursement cuts are inevitable in the current scenario, one of the major concerns is that these cuts should not limit patient access to care at the time when they need it the most.
There has been a paradigm shift in the coding and billing policies for providers including the reimbursements for orthopedic surgeries. CMS has announced various policies in 2021 under Medicare Physician Fee Schedule (MPFS) to reduce orthopedic surgical services by at least 5%. This is bound to add to the financial burdens of orthopedic hospitals and practices that are already adversely affected by the financial impact of the public health emergency.
This article focuses on the top reasons for claim denials in orthopedic billing and gamechanging strategies to improve orthopedic surgery reimbursements
Three types of denials constitute orthopedic billing.
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To learn more about how your healthcare organization can prevent orthopedic denials and improve denial management services, talk to our team.
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