Running an orthopedic practice means dealing with expensive surgeries and insurance companies that scrutinize every detail. Some practices collect what they’re owed. Others struggle to bring in even 80% of their revenue.
You perform a hip replacement. Six months later, you’ve collected maybe 70% of what you billed. This pattern repeats, and before long, you’re missing significant revenue. These hidden revenue leaks drain most practices without anyone noticing.
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TALK TO AN EXPERTComprehensive Charge Capture: Eliminate Revenue Loss
Unbilled services are lost revenue. Things slip through: implants, injections, in-office X-rays, surgical assistance.
Create procedure checklists. Review charges daily. By the time you realize something’s missing, it’s often too late.
Insurance Contract Analysis and Negotiation
Most practices accept contracts without digging into the numbers.
Pull reports on what each insurer pays. You might discover consistent underpayments that nobody caught. Contract renewal coming up? Ask for rate increases. They won’t offer them automatically.
Network Credentialing and Provider Enrollment
Being out-of-network can slash your reimbursement significantly.
Track every network you’re in. Note expiration dates. Look at your patient base – if you’re seeing lots of patients with a particular insurance but you’re not in their network, fix that.
Accurate Payment Posting and Reconciliation
Payments get posted to wrong accounts. Insurance adjustments get missed. Underpayments slip through.
Post payments the day they arrive. Review them weekly.
Accounts Receivable Follow-Up Strategy
Old claims rarely pay themselves. Claims over 60 days need phone calls. Claims over 90 days are your priority list.
Denial Management and Appeals Process
Every denied claim puts your money at risk. Speed matters.
| Why It Got Denied | What Actually Happened | How to Prevent It |
| Missing approval | You did the surgery but nobody got insurance clearance first | Add authorization tracking to your scheduling system – don’t schedule until approval is in |
| Filed too late | Claim sat on someone’s desk too long and missed the deadline | Make it a rule: submit every claim within one week of the service date |
| Wrong insurance billed | Patient has two insurance plans and you billed the secondary one first | Ask every patient which insurance is primary during check-in, every single time |
| Not medically necessary | Insurance is questioning whether the patient really needed the procedure | Send detailed notes and test results with the claim, not after they deny it |
| Info doesn’t match | Patient’s name or birthday in your system doesn’t match insurance records | Verify patient information at every visit – people change addresses, get married, update their names |
Review denials the same day they arrive. Don’t let them stack up in someone’s inbox.
Build templates for common appeal letters. When you’re fighting the same denials repeatedly, your template should already include the documentation insurance usually asks for.
Track what’s causing denials. If authorization issues are behind most rejections, you know exactly where to focus your effort.
If denials are overwhelming your team, professional denial management services can recover lost revenue and fix recurring problems.
Patient Payment Collection Best Practices
High deductibles mean patients owe more than ever. Call them before their procedure. Tell them what they’ll owe. Collect half upfront.
Break big balances into monthly payments. Accept credit cards despite processing fees – better to collect most of the money now.
Make statements clear: total charge, insurance payment, patient balance.
Key Performance Metrics and Reporting
You need to track what’s actually happening with your money. Collection rates tell you if you’re getting paid what you should. Payment timelines show how long money sits in limbo. Denial rates reveal if claims are getting rejected too often.
Check these monthly. When collection rates drop or denials spike, dig into why it’s happening. Waiting until quarterly reviews means you’ve lost three months of revenue.
Technology Implementation for Revenue Optimization
Buy software that solves actual problems you’re facing, not because everyone else has it.
Insurance verification tools catch coverage problems before patients show up. That alone saves you from providing services you can’t bill. Claim scrubbers review your submissions and flag errors before they go to insurance – catching a wrong code now beats appealing a denial later.
Patient portals let people pay whenever it’s convenient for them. No more phone tag or waiting for checks. Automatic payment posting takes insurance payments and records them without your staff typing every entry.
Some practices are now looking at how AI is transforming revenue cycle management – these systems can spot patterns in denials or predict which claims might have issues before they’re even submitted.
Partnering with Revenue Cycle Management Specialists
Red flags: Claims keep getting denied. Payments take forever. Collection rates stay low.
Look for billing partners who understand orthopedic practices with transparent pricing. Specialists in orthopedic billing services can make a real difference.
MedLife works with orthopedic practices to improve collections and reduce claim denials. If you’re looking to tighten up your revenue cycle, we can show you where money’s getting stuck and help fix it. Schedule a free assessment or call (888) 668-7770.