Orthopedic medical billing requires accurate coding, modifier management, global period tracking, implant documentation, and workers’ compensation expertise. MedCare MSO combines AAPC-certified coders and AI-powered workflows to validate claims before submission.
Orthopedic care has completely changed due to advances in the specialty. Starting from joint replacement to outpatient spine surgery, treatments have improved, but at the same time, complexity has increased for the medical billers. Outsourcing to experienced orthopedic billing experts has proven to increase revenue and reduce the administrative strain these high-dollar surgical claims create.
MedCare MSO provides your practice with end-to-end orthopedic billing services covering the coding, billing, denial management, and A/R follow-up. Our team provides billing support for arthroplasty, fracture care, spine procedures, arthroscopy, and complex orthopedic surgical workflows.
Orthopedic billing encompasses various complex procedures, implant handling, guidelines for multiple procedures, rules on global surgery, accuracy in laterality, and workers’ compensation claims. We solve problems that arise as a result of various coding requirements and national rules, thus helping orthopedic clinics prevent refusal of payments, facilitate cash flow, and improve financial results. Such unique competence is what differentiates orthopedic billing companies from regular providers.
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Orthopedic surgery billing includes some unique elements, such as implant-related issues, modifiers, global period information, laterality accuracy, and workers compensation regulations. Our orthopedic medical billing services assure that these elements are taken into account, which is why generalists miss what specialists notice.
Orthopedic surgical procedures include using joint implants, spinal implantations, and bone grafting types that abide by rules that vary according to the insurance carrier and respective contracts. Incorrect reporting of the orthopedic implants may cause delays in payments, reductions of claims or even denials. We maintain proper documentation, bills, and tracking of the products as required by each specific case.
Global period billing works in a similar way. Fracture care revolves around a 90-day window, while minor procedures are worked around 0 to 10 days, and each window decides which follow-up is bundled. We date every procedure by surgeon and attach modifier 24, 58, 78, or 79 to the encounter that earns it.
Orthopedic practices often lose reimbursement due to incorrect bilateral procedure billing. Modifier 50 and lateral modifiers such as RT and LT should not be confused with one another among the payers as their wrong usage may lead to denial or overpayment and thus a possible audit process. We know how to apply the right modifier depending on the payer.
Sequencing is just as important. Under the multiple procedure payment reduction, under MPPR, Medicare pays the highest-valued procedure at 100% and applies a 50% reduction to each additional procedure. The procedures are ranked by their relative value, and modifier 51 is only used where required taking into account that add-on codes are excluded from this procedure.
Book a Free ConsultationDifferent CPT codes are involved in arthroscopic and open methods. Any confusion about surgical documents can eventually lead coders to pick the wrong one. In order to achieve accuracy, our orthopedic coders examine the medical record and ask the doctor questions rather than making assumptions. Both modifier 22 and claims for expensive implants rely on such documentation.
Workers’ compensation billing requires state-specific fee schedules, authorization workflows, and utilization review compliance. We work across all 50 states and use a longer billing cycle. The same thing can be said about some orthopedic surgeries performed in ASCs, which also require authorizations to be done in advance.
High-value orthopedic claims, including joint replacements and spinal fusions, require detailed documentation to pass payer audits. The highest priority in payer audits is given to joint replacements and multi-level spinal fusions. The completeness of operative notes and documentation of implants is checked first.
Also, necessary out-of-network orthopedic services must comply with the No Surprises Act. Instead of waiting for a request, we collect audit-ready claim packages while building each claim. Work on orthopedic coding compliance becomes a simple matter of providing proof of compliance as needed instead of hoping it will be upheld.
Protect My RevenueOur services for orthopedic billing span the entire revenue cycle, starting from orthopedic billing and coding to the A/R follow-up. Our expertise stops errors that general experts would miss, automation catches things that mass processing may overlook, and our company combines both aspects to uncover potential problems before they cause any trouble during the denial stage.
Each orthopedic subspecialty requires specific coding guidelines, documentation standards, and payer requirements. Billing differs meaningfully across orthopedic subspecialties, so each requires its own coding and documentation approach rather than a single consolidated process.
Joint replacement billing involves total knee arthroplasty (CPT 27447) and total hip arthroplasty (CPT 27130), as well as billing for component parts, client documentation, and revision codes that are needed for these types of cases.
Spine surgery billing based on different approaches with coding according to cervical, thoracic, and lumbar fusions, with codes CPT 22551 and 22612 and with related additional codes, in addition to completing coding for instrumentation and biologics.
Arthroscopy billing that selects the primary CPT code based on the type of joint, thus including debridement, meniscectomy, chondroplasty, and labral repairs as well as rotator cuff procedures.
Fracture care billing for both closed and open procedures, applying the global period and correctly encoding all information related to casting and splinting and traumatic cases.
Musculoskeletal billing procedures are based on the offered services instead of being generalized into one billing category through the use of evaluation and management codes.
ASC orthopedic billing methods accurately identify the exact point of service and are responsible for identifying the professional and facility related to the service offered.
Surgery of the extremities involves ensuring that appropriate laterality on each claim and the right open versus arthroscopic code are used to determine if the service is paid or denied.
Billing for the HCPCS L codes consists of braces and other fitting devices as part of the documentation of medical necessity and to ensure coverage is granted.
High-volume hospital-based orthopedics that are billed with accuracy for both facility and professional components among the many surgeons and payers for each contract.
See how our orthopedic billing experts identify reimbursement gaps, improve claim accuracy, and optimize your revenue cycle performance.
Orthopedic claims, for example, a joint replacement claim alone, go through several processes between the operative note and the payment. Our four-layer AI-driven approach helps effectively patch the gaps where orthopedic revenue often leaks and four connected products run on top of it. Take the whole AI Ecosystem or wire a single piece into the EHR you already run.
The orthopedic records are managed with operations from the stage of documenting the procedure and in regard to its charges.
It captures the operative detail coders need to justify the use of modifier 22 and implant claims, from the point of care.
Sophos helps with CPT, ICD-10, and HCPCS assignments for orthopedic processes like arthroplasty, spine, and arthroscopy that are reviewed by our expert coders.
Maximus runs scheduling, eligibility, and claims from one platform, with Power BI dashboards on collections by surgeon and payer.
Four connected layers sit under every product, and it is this stack that turns a complex orthopedic claim into a clean one before a payer ever sees it.
Transfers claim, eligibility, and payment data from your system without having to manually enter any information.
Monitors claim status and payer activity to identify orthopedic denial patterns before the end of the month.
Uses orthopedic-specific edits, NCCI bundling, and global period logic to process the claim.
Carries out coding assistance, denial procedures, and follow-up in connection with claim volume.
Our experience with MedCare MSO has been consistently positive and in particular the support and professionalism provided by James Archer.
Founder, ODAT Services
I highly recommend MedCare MSO if you are looking for help with your billing and gain some freedom to see more patients or manage your business.
Practice Owner, TXEC
MedCare MSO has been an excellent organization to work with, I highly recommend them for their quality of service and commitment to excellence.
Back Office Manager, STST
We are definitely impressed by the Team’s performance. I worked with a lot of different folks from all over the world on different business transactions, and Mark is truly a top notch talent!
Director of Corporate Development, SC & SF
MedCare MSO’s exceptional communication and expertise elevated our RCM experience and my bank accounts!
Owner, R.D.
MedCare MSO did a great job with our billing and helping clean up old AR. Regular updates and good communication were very appreciated.
Co-Owner, PCP
Chief Operating Officer, MAKO MEDICAL LABORATORIES
Chief Executive Officer, CARE NOW CLINIC
Chief Operations Officer, ION DIAGNOSTICS
Co-Founder, AW Care
Working with MedCare MSO has been a game-changer for my practice. Their expertise in medical billing, AR management, and coding has significantly streamlined our revenue cycle, reduced claim denials, and improved cash flow. The team is proactive, detail-oriented, and always available to address my concerns.
Practice Owner, F&A Clinic
We have experienced tremendous improvements within our billing and claims department that we have entrusted MedCare MSO to manage.
President/CEO, RLT
I am impressed with MedCare MSO’s promptness to respond to any inquiries, with the time they dedicate to reviewing each one of the cases.
Practice Owner/FBH
When selecting the best orthopedic billing service, it is advised to look for AAPC certified coders who have experience in global billing, implant billing, and modifier 50 billing. Ensure to find out their level of transparency, especially the service charge they impose when providing the service as well as their history of clean claims submission. A good orthopedic billing service provider offers the service to small institutions and does not offer substandard service.
The cost to outsource orthopedic billing services depends on various factors like the number of claims submitted and the nature of services. It means that there is no flat rate given since most orthopedic facilities prefer paying a percentage of the amount received. Schedule a call with our representative to negotiate the price.
Absolutely. We offer orthopedic billing and coding services as well, including provider credentialing and payer enrollment for surgeons, PAs, and NPs in the area of orthopedic billing involving commercial insurance, Medicare, Medicaid, and Workers' Compensation. The importance of updated credentials cannot be overstated as failure to do so may lead to issues with regard to claims denial and delays.
Our team maps out your workflow, connects to your systems, and runs a parallel period while your claims are still being processed. This ensures that everything runs smoothly. We also reconcile scheduled procedures with charges during the process so that no revenue is lost.
We work with top orthopedic EHR, EMR, and practice management systems so that we can work inside your existing system rather than forcing a change.That keeps your clinical workflow intact while our orthopedic billing and coding services handle charge capture, claims, and denials behind it.
Please provide the following information, so our team can connect with you within 12 hours.
Or call us as 800-640-6409
ODAT Services
I am writing on behalf of ODAT Services to express our strong satisfaction with MedCare MSO, and in particular the support and professionalism provided by James Archer.
Our experience with MedCare MSO has been consistently positive. The team has demonstrated reliability, responsiveness, and a clear understanding of the operational and compliance needs of our organization. James Archer has been especially instrumental—bringing a high level of expertise, clear communication, and a solutions-oriented approach to every interaction.
James is proactive, knowledgeable, and dependable, making complex processes easier to navigate and helping ensure our operations run smoothly. His professionalism and commitment to service have made MedCare MSO a valued partner to our organization.
We are pleased to recommend MedCare MSO and James Archer without reservation and look forward to continuing our work together.
Travis Gannon
Founder
ODAT Services
TXEC
I have worked with MedCare MSO for the past eight months, and it has been a great experience. Moses, Mark, Travis, Sebastian, and Tammy have been a pleasure to work with, as well as the rest of the team, including the credentialing folks.
I highly recommend this group and MedCare MSO if you are looking for help with your billing. They will meet with you once a week to review the issues that need to be fixed to improve your payment and capture rate.
If you are looking for help with your billing and gain some freedom to see more patients or manage your business, this is the team you need to work with.
Dr. Jose Correa
Practice Owner
TXEC
STST
MedCare MSO has been an excellent organization to work with. Mark has consistently demonstrated outstanding attention to detail, thorough documentation, and strong professionalism in maintaining accurate records of his findings.
His reliability and dedication have contributed greatly to a positive experience.
I highly recommend MedCare MSO for their quality of service and commitment to excellence. I can’t say enough good things about Mark and his company.
Thank you
Shaunna Mock
Back Office Manager
STST
SC & SF
Hi Ali, I hope this message finds you well. I wanted to give you some feedback on the team.
We are definitely impressed by the Team’s performance. Definitely what we were looking for from switching partners.
In particular Mark Zaiden has been very helpful. In my 5+ years of experience as a M&A Professional, I worked with a lot of different folks from all over the world on different business transactions, and Mark is truly a top notch talent!
Austin has done a great job of leading the communications process and keeping the train going in the right direction. Tammy and some other folks have been key players as well. We really are happy with everyone on the team.
I wanted to pass this feedback along to you as we are really pleased with working with MedCare MSO so far.
Have a great weekend!
Max Owens
Director of Corporate Development
SC & SF
R.D.
MedCare MSO’s exceptional communication and expertise elevated our RCM experience and my bank accounts!
Most helpful is the open/responsive communication of their team with my office and each other, along with the specialty levels of expertise amongst my team for each aspect of RCM.
Kelly Ballou
Owner
R.D.
F&A Clinic
Working with MedCare MSO has been a game-changer for my practice. Their expertise in medical billing, AR management, and coding has significantly streamlined our revenue cycle, reduced claim denials, and improved cash flow. The team is proactive, detail-oriented, and always available to address my concerns.
I would like to take time to recognize two members of MedCare MSO specifically. Moses for his exceptional support and dedication. He is always responsive, and knowledgeable, and goes above and beyond to ensure smooth operations. His professionalism and commitment make a huge difference in our day-to-day workflow. George also for his quick feedback and recognition of what is needed most. He is extremely efficient and always available for clarification and to share his knowledge and expertise.
I highly recommend MedCare MSO to any healthcare provider looking for a reliable and efficient billing partner.
RLT
Hello,
I am writing this email to express our appreciation of the MedCare MSO’s team and all they have done for our business at RLT. In the past year, we have experienced tremendous improvements within our billing and claims department that we have entrusted MedCare MSO to manage. We went from having over $100k in uncollected/billed claims to now reaching near $100k in collection some months.
We are also happy to express our thankfulness that MedCare MSO is now helping us acquire new contracts with different insurance companies. This will in effect benefit everyone involved, allowing us to expand our services and provide more resources for our staff/business partners.
Please note special appreciation for the following:
David Lucas
Mario Ortega
Ambrose William
FBH
I have been a customer of MedCare MSO for one year. They have provided billing and credentialing services for my private behavioral health practice, and I am impressed with their promptness to respond to any inquiries, with the time they dedicate to reviewing each one of the cases, and with their willingness to educate me and my staff about the ever-changing rules of medical billing and the best use of coding. This is a company I Trust with my billing needs.
Dr. Neufeld
Practice Owner
FBH
