Improve Orthopedic Collection Process

2. Improve Orthopedic Collection Process Orthopedic practice owners are struggling to maintain the financial stability of their practice. There are many reasons for this struggle as expenses aren’t declining while reimbursement from payers isn’t increasing. As per a recent orthopedic billing survey, more than 30% of orthopedic surgery claims are incorrectly submitted. Such a high portion of rejected and denial claims could severely affect your practice revenue. Also, more patients are choosing high deductible health plans which are leading to high patient responsibility and hence high unpaid AR is affecting practice bottom line.  Recently, office services have increased in orthopedic practice setup. Office services derived revenue could contribute more than 50% up to 75% of orthopedic surgeon’s total revenue. This increased portion of office services suggests a change of approach towards collecting patient portion amounts. With higher patient co-pays a patient may have a $60 co-pay for a $100 office visit, even if insurance has paid its portion, a better collecting approach is required to collect the remaining 40% of revenue. In this blog, we shared a few practical ways to improve your orthopedic collection process.  Orthopedic Collection Process Share Procedure Estimate

3. Improve Orthopedic Collection Process • Clearly communicating with your patients for their procedure estimates, plays a crucial role in your practice collections. Providing the procedure estimate is the first step in price transparency. You can provide better customer service by sharing estimates of their financial obligation prior to surgery. You should train your staff for better patient communication and coordination.  • Once the decision for surgery is made, your eligibility and benefits verification team should verify the patient’s benefits including the remaining deductible and remaining out-of-pocket expense. Most of the payers will provide procedure estimates in real-time. Or you can simply call insurance companies and get updated patient eligibility and benefits data in real-time. • Try to share the most accurate estimate possible to patients to collect the full patient portion. When you share an estimate, you have to clearly mention that it’s an estimate and the actual charged amount will change as per payer policy. • Based upon estimates, most orthopedic practices attempt to collect complete patient responsibility as a deposit.

4. Improve Orthopedic Collection Process • While other practices try to collect 50% of patient responsibility. This percentage depends upon the efficiency of your team to collect patient responsibility after the procedure. If your team is well connected with patients and they are confident about collecting the complete patient portion then you can collect all at the end of the procedure.  • A patient who is well informed about his procedures and his financial obligation can make better decisions about his procedure. Often patients cancel surgery at the last minute because they are unable to pay their portion. Establishing this financial relation and discussing prior financial arrangements leads to lesser patient outstanding amounts. • Collect at the Time of Service • Your team should be well informed about the dollar value of CPT codes, co-pays, deductibles, and overall patient financial obligations. Due to this when patient check-in, your staff will be well informed about the patient portion and they can provide detailed information about services offered. 

5. Improve Orthopedic Collection Process • As discussed earlier, a critical step of collecting at the time of service is to inform patients of their probable charges when they schedule their appointment. A sample script could be, “Based on the reason you’re coming in, it’s likely Dr. Stan will obtain X-rays of your knee. These X-rays are not covered under your co-pay. Based on the information I obtained from your insurance company and our contracted rates with them, we estimate you will owe approximately $XXX.” • You should train your staff to read and interpret patient eligibility and benefits information. Your staff should easily interpret remaining deductible, co-insurance, and out-of-pocket benefit information.  • Measure Efficiency of Collection Process • You should have a systematic approach towards the collection process whether it’s the insurance portion or patient portion. You can store collection process data in terms of various report formats. Reporting formats like weekly patient/insurance collections, write-off amounts-patients and insurance wise, Number of denied claims, accounts receivable amounts with 30-60-90-120 days bucket, and others. As per the need of your practice you can set a few collection metrics and try to follow them strictly.  • Even though one can have an efficient in-house team and train the staff, the orthopedic billing process is too complex to handle by the in-house team. So, outsourcing your orthopedic billing and coding requirements to an experienced medical billing company can help you reduce your stress on your team and can improve your orthopedic collection process.

6. Improve Orthopedic Collection Process To know more about our orthopedic billing and coding services, contact us at info@medicalbillersandcoders.com/888-357-3226.