Running an orthopedic practice is no small feat. Every day, you deal with complex surgical billing, high patient volumes, and complex contracts. Together, these factors can turn revenue cycle management for orthopedics into a nightmare.
Every task demands precision to ensure timely payments and a healthy bottom line. The question is, how do you develop more efficient orthopedic RCM processes? You’ll need the right tools, policies, and mindset to maximize your cash flow and grow your practice. Here’s what you need to know about RCM orthopedics strategies and solutions.
Orthopedic revenue cycle management is challenging because of these factors.
There are few things routine about orthopedic RCM. Orthopedic practices offer services that range from diagnostic visits to intricate surgeries like spinal fusions.
The complexity of billing for diverse procedures often leads to claim errors. For instance, billing for a joint replacement involves bundled payments. These mistakes slow down cash flow and pile on the administrative work.
Revenue cycle management for orthopedics involves dealing with a higher risk of denials. Every claim must use precise CPT and ICD-10 codes. Even a simple mistake can lead to a denial, especially for high-cost surgeries.
While you can’t let that revenue slip through the cracks, you also can’t afford to rework and resubmit every claim. Doing so eats up time and takes away from the patient journey.
Revenue cycle management for orthopedics involves navigating complex payer-provider contracts. Each contract has specific reimbursement rates, which means contracts and contracted rates are difficult to manage. Without clear visibility into denial trends, you’ll encounter frequent payment variance.
Great RCM orthopedics practices streamline the path from service to payment. The goal is to minimize denials by addressing every stage of your revenue cycle, including patient intake, claim submission, and denial management. Here’s what it takes to win at RCM management in the orthopedics sector.
Orthopedic surgeries come with high costs for both providers and patients. Accurate upfront estimates ensure your patients know their out-of-pocket obligations, which reduces the risk of unpaid deductibles.
You need to provide accurate estimates for compliance purposes and to promote cash flow. Collecting what you are owed before services are provided helps you break out of the vicious lost revenue cycle.
Want to learn more about the value of upfront estimates? Download our free webinar, Reasons for Rivet: Insights from Bluegrass Orthopaedics.
Manually requesting a prior authorization slows down the delivery of care and disrupts cash flow. Automating these processes can increase accuracy in requests for approval, accelerate the prior authorization process, and reduce the risk of errors that leave your patients stuck with huge bills.
No matter how careful you are, some claims are going to get denied. What matters is how many claims get through clean and how you respond to those that are kicked back. You need the right tools so you can quickly identify which claims should be resubmitted and avoid wasting resources on low percentage denials.
With an orthopedic RCM platform, you can regain control of your revenue cycle. What does the right solution look like? Choose software that includes these critical features.
Your practice juggles multiple contracts with varying rates for the same procedures. Tools that track payment accuracy and highlight variances with a particular payer-provider contract empower you during contract communications.
You can use this data for improved contract management and potential contract changes. Identify concerning denial trends sooner and fight for the revenue you’ve earned.
Automation catches coding errors and omissions before you submit them. The goal is to reduce denials without slowing down your claims processing workflows. Submitting claims with greater speed and accuracy will provide the cash flow necessary to grow your practice.
Are payer-provider contract terms being effectively tracked and managed? The chances are that at least a few of them are underperforming. Deep analytics tools let you benchmark reimbursement rates against industry standards, revealing opportunities to renegotiate contracts.
In the past, a typical orthopedic practice entered into negotiations at a disadvantage. Reimbursement analytics tools help you align expected and actual revenue.
Rivet Health’s payer performance solutions have a proven track record of delivering value for orthopedic practices like yours. Learn how to improve reimbursement and manage contracts in this customer story Real Reasons for Rivet: Insights from Boulder Centre for Orthopedics & Spine.
Rivet Health’s suite of tools — Revenue Diagnostics, Payer Performance, Patient Pricing, and Claim Resolution — addresses each of the major pain points of revenue cycle management for orthopedics. With our platforms, you can:
Our platform offers seamless EHR/EMR integration and comes with top-tier customer support. Learn more about Rivet’s healthcare revenue cycle management solutions for orthopedic practices.
Rivet Health’s RCM solutions include unique features specifically designed for orthopedic practices. With Rivet, you receive hands-on customer support, integrated tools, and an intuitive user interface.
Our platform has delivered tangible results for countless clients, such as Resurgens Orthopaedics. This Atlanta-based practice used Rivet to decrease A/R days, improve day-to-day workflows, and overcome long-standing billing challenges.
Learn more about the value of efficient denials management and resubmission in our free webinar, featuring Resurgens Orthopaedics.
Effective revenue cycle management for orthopedics reduces denials, accelerates payments, and lets your practice focus on delivering exceptional care. At Rivet Health, we offer tailored solutions to simplify payer contracts and boost upfront collections.
Ready to transform your practice’s financial health? Schedule a demo with Rivet Health.
