Maximize Reimbursements. Minimize Denials. Stay Focused on Patient Care.
Orthopedic Medical Billing & Coding Services
We specialize in orthopedic billing, coding, and revenue cycle management—including fracture care (CPT 27506), joint injections (20610), and complex surgical claims.
Our certified coders and billing experts ensure faster payments, cleaner claims, and 100% compliance with NCCI and LCD policies.
96%
Clean Claim Rate
4.2%
Denial Rate (vs. 18% Avg)
EHR
Working with all major EHR Partners
HIPAA
Compliant Workflow
Free Credentialing with Medical Billing
$499 / Month
Call / WhatsApp:
(716) 919-3969
Email:
support@rxcredentialing.com
www.rxcredentialing.com
Orthopedic Medical Billing Services
Medical Billing Services
- ✅ Smooth transition between EHR/EMR systems.
- ✅ Efficient Electronic Funds Transfer (EFT), EDI, and ERA setups.
- ✅ Claims submission within 24 hours.
- ✅ Prompt follow-up with payers for faster reimbursements.
- ✅ Free CAQH maintenance and provider revalidation.
- ✅ Comprehensive Revenue Cycle Management (RCM) services.
- ✅ Appeals, adjustments, and coding review included.
- ✅ Referral coordination with other practices and specialists.
- ✅ Reimbursement strategies for optimized billing.
Certified coders and Billing experts
Biggest Orthopedic Medical Billing Challenges
Global Period Confusion
Misunderstanding 90-day global periods for surgeries (CPT 29881, 27447) leads to 35% underbilling of eligible E/M services.
Our Expertise:
AAPC-certified orthopedic coders correctly identify billable services within global periods
Modifier Misuse
Incorrect application of modifiers -59, -RT/-LT, and -X{EPSU} causes 42% claim denials for orthopedic practices.
Our Expertise:
Modifier logic audits reduce denials by 78%
DME Billing Errors
L0631 braces and other DME items have 55% rejection rates due to documentation gaps.
Our Expertise:
DME-specific checklists ensure 98% approval
Workers' Comp Delays
WC claims take 3x longer to process due to state-specific forms and documentation.
Our Expertise:
State-specific WC teams cut processing time by 65%
Physical Therapy Bundling
97110/97140 codes get bundled 60% of the time when billed with surgical procedures.
Our Expertise:
Timing strategies unbundle 85% of PT services
MIPS Penalties
Orthopedic surgeons lose 9% of Medicare payments due to MIPS non-compliance.
Our Expertise:
Custom MIPS tracking for ortho-specific measures
Schedule a Consultation with Our Medical Billing Experts
We understand your need to keep things small, intimate, and personalized. Our medical billing specialists for independent small practices thoroughly study your needs and offer custom-made solutions.
Orthopedic Medical Billing
We Offer
Orthopedic Medical Billing
Process
Benefits of Outsourcing
Orthopedic Medical Billing
Specialized Orthopedic Coders
AAPC-certified coders proficient in arthroscopy (29877), joint replacements (27447), and fracture care codes.
30% fewer coding errorsHigher Clean Claim Rate
Pre-submission audits for modifiers (-59, -RT/-LT) and global periods.
95% first-pass acceptanceFaster DME Approvals
Streamlined documentation for L0631/L0641 braces and other orthopedic devices.
78% faster DME paymentsWorkers' Comp Expertise
State-specific WC claim teams familiar with orthopedic injury billing requirements.
60% reduction in WC denialsMIPS Optimization
Ortho-specific quality measures tracking (e.g., #110, #178).
92% achieve bonus paymentsTransparent Reporting
Real-time dashboards show surgeon-specific collections and denial trends.
25% revenue increase avg.Orthopedic Medical Billing
FAQs
How do you handle 90-day global periods for orthopedic surgeries?
We use proprietary tracking software to identify billable E/M services within global periods (e.g., unrelated visits, complications). For CPT 27447 (TKA), we typically find 3-5 additional billable encounters per case, increasing revenue by 18-22%.
What's your denial rate for arthroscopy codes (29877-29889)?
Our pre-submission audits maintain a 4.2% denial rate for arthroscopy procedures (vs. 19% industry average) through:
- Proper modifier -59 application
- Laterality verification (RT/LT)
- Documentation cross-checks for surgical notes
Do you support workers' compensation billing for orthopedics?
Yes. Our WC specialists handle all state-specific requirements:
- California DWC-1 forms with PR-2 reports for spinal cases
- New York C-4 forms with MG-2 treatment plans
- Texas DWC-69 for designated doctor reviews
We achieve 67% faster payments on WC claims compared to in-house billing.
How do you bill for post-op DME like L0631/L0641 braces?
Our DME billing protocol ensures 98% approval rates by:
- Verifying CMN completeness (Section C for orthotics)
- Attaching operative notes showing medical necessity
- Using KX modifiers for surgical patients
- Submitting within 7 days of provision
Can you help with MIPS reporting for orthopedic surgeons?
Absolutely. We focus on ortho-relevant measures:
| Measure | Description | Target |
|---|---|---|
| #110 | Pre-op IV antibiotics for TJA | 100% |
| #178 | Rheumatoid arthritis management | ≥50% |
92% of our clients receive positive payment adjustments.
What's your process for fracture care billing (CPT 25600-25695)?
We implement a 3-step verification:
- Documentation Review: Confirm global period (90 vs. 10-day)
- Modifier Application: -54 for surgical care only
- Follow-up Tracking: Bill subsequent E/M with -24 modifier
This reduces denials by 73% for fracture care.
How do you handle bundled physical therapy services?
We unbundle PT services (97110, 97140) through:
- Timing: Separate encounter days from surgeries
- Modifiers: -59 for distinct procedural services
- Documentation: Specific goals unrelated to post-op recovery
This recovers $28k+/year for the average orthopedic practice.
Do you work with ASCs for orthopedic procedures?
Yes. We specialize in ASC-specific requirements:
- Separate facility vs. professional fees
- Correct use of -SG modifier
- Device-intensive procedure coding (e.g., C1734 for anchors)
Our ASC clients see 22% higher collections than industry averages.
What's included in your orthopedic billing reports?
Our monthly reports feature ortho-specific metrics:
| Metric | Benchmark |
|---|---|
| Surgeon-specific RVUs | vs. MGMA data |
| Global period utilization | Missed E/M opportunities |
| Top denial reasons | Modifier vs. documentation |
How quickly can you start billing for our practice?
Our streamlined onboarding takes 7-10 business days:
- Day 1-2: EHR integration (Epic, Cerner, etc.)
- Day 3-5: Surgeon-specific code preference setup
- Day 6-7: Test claim submissions
- Day 8-10: Staff training & go-live
First payments typically arrive within 14-21 days.
Orthopedic Medical Billing
Insurances Covered
Medicare
Medicaid
VA Health
TRICARE
ACA Marketplace
UnitedHealthcare
Aetna
Cigna
Humana
Anthem
BCBS National
BCBS Alabama
Florida Blue
BCBS Michigan
Empire BCBS
Horizon BCBS
BCBS NC
Highmark BCBS
BCBS Texas
Premera BCBS
Kaiser Permanente
Molina
Centene
Oscar Health
Health Net
CDPHP
Capital Blue
Independence BC
CareFirst
Regence BCBS
UHC Medicare
Humana Medicare
Aetna Medicare
Cigna Medicare
BCBS Medicare
Trusted Medical Billing Services
Verified Results
Rx Credentialing LLC did an excellent job helping my practice join the MCOs. Their team made the process seamless and stress-free, answering all my questions promptly. I highly recommend them—their service is efficient, professional, and reasonably priced! 😁
I am a licensed psychotherapist and could not be more pleased with the efficient, professional services from RX credentialing services. No AI or bots here. Instead, RX offers real human beings who understand the needs of solo providers or group practice owners who are spread thin and have to wear many hats. Rx has hired talented individuals, like my account manager, Tyler, who will go the extra mile for you to ensure credentialing goes smoothly. We hit a hiccup on the road to becoming credentialed, but Tyler quickly intervened, advocating for my business so that the issue was resolved and I was approved for various insurance panels--some which have very high bars or administrative requirements. RX handled it all, informing me through each step of the process with clear and concise credentialing updates that put my fears to rest. Their services are kind of like therapy for therapists, because when you worry less about admin burdens, you can better focus on the client, while growing your business capacity. I would highly recommend them to any solo or group practice needing such services.
RxCredentialing has been a wonderful partner in helping with my credentialing for my new primary care practice as well as are assisting me with a few other services. They are very knowledgeable and most importantly they are not pushy in working with my needed timeline. Moreover, they are very responsive, and I am looking forward to expanding our relationship to include their other services such as medical billing. I was fortunate to find them while searching the web and so refreshing to deal with an organization that is really focused on helping me establish a medical practice the smart way and not just spend money foolishly on things I do not need until the time is right.
Adam and his team are excellent at what they do. They walk you through every step of the process. Highly recomend Adam and his team. always responding in quickly.
Attention to detail
Very attentive and efficient
Always available to explain things or answer questions or concerns
Very attentive and efficient
Always available to explain things or answer questions or concerns
Tyler has been an excellent person to work with. He kept us (our clinic) informed of our status throughout the credentialling process. They did the "heavy lifting" tracking down and following up so we didn't need to. Because this company handled our credentialling process, it allowed our company to focus on our number one priority--patient care. Thanks for taking care of us!!
they handled the issue quickly and professionally. I truly felt supported and confident in their assistance.
I can’t say enough great things about RX Credentialing! From the beginning, they’ve been incredibly efficient, responsive, and always a pleasure to work with. Anytime I had a question or needed assistance, they got back to me quickly with clear, helpful answers. They made the entire credentialing process smooth and stress-free! It truly feels like they care about their clients and go the extra mile to make sure everything is handled correctly and on time. I would highly recommend RX Credentialing to anyone looking for a credentialing partner who delivers every time!
David is wonderful very responsive and on top his work. Great experience.
Making the decision to use Rx Credentialing for my billing service was a game changer for my practice. Solo practice as an NP and lipid specialist has been challenging for sure. Rx Credentialing has provided the professional knowledgeable support I needed. I am so grateful to be partnering with them for my billing and credentialing needs.
The staff is great and very helpful. I have been with them for 2 years with no complaints. I am very satisfied with their service.
I have been working with this company for over a year and I have no complaints…They are really the best at what they do.
Trusting a third party with your sensitive information can be difficult. I encountered this challenge while seeking credentialing services for my business with various insurance providers. Although I received numerous proposals from credentialing firms, I was uncertain about the security of my personal data. A trusted colleague recommended Rx Credentialing LLC, based on her positive experience. I decided to engage their services, and I’m pleased to report that they handled my information securely. Moreover, their expertise and competitive pricing make them an excellent choice for anyone needing credentialing support.
Adam is very professional and kind, always responsive when I need assistance. I have billing service through this company which has been going good so far. I was lucky enough to get a wonderful virtual assistant from Adam, I don’t know what I would do without her.
Rx Credentialing did a phenomenal job assisting with credentialing for my Ophthalmology practice start-up. Tyler is responsive and kept me up to date throughout the entire process. I would recommend Rx Credentialing to anyone hands down the best. Dr. Montenegro.
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