Orthopedic Account
Receivable Recovery
MedPro Services, Inc is a full-service Orthopedic account receivable management company. MedPro Services, Inc has the expertise and extensive orthopedic knowledge to investigate and recover aged insurance claims in every financial class.
Medical Billing Recovery
MedPro Services provides medical billing AR recovery services for orthopedic clinics and providers seeking to improve cash flow on earned but unrealized revenue for services provided. Whether a clinic’s AR is unrealized, challenging to work, or the clinic’s internal staff is “overwhelmed,” this continues to be a significant business challenge for medical providers. The current economics of the healthcare industry is defined by a combination of increasing costs and decreasing reimbursement rates. MedPro Services, Inc understands that medical billing has become highly complicated in the last several years with the ever-changing rules from CMS and commercial payers. Our staff attends coding classes annually and throughout the year for continuous education in the orthopedic specialty. MedPro Services subscribes to all insurance carriers’ newsletters to keep abreast of changing rules.
Our expert staff is well experienced and educated with the complete musculoskeletal system, including but not limited to:
- Shoulder, Knee, and Hip Replacement
- Procedures and surgeries associated with Osteoarthritis
- Micro hand surgeries
- Spine Surgeries
- ACL, meniscus repairs, Chondroplasty
- Rotator cuff, Labrum tear, Synovectomy, Bursectomy, Biceps Tenodesis
- Below and Above Knee amputations are usually associated with diabetes, gangrene
- Open reduction with internal fixation procedures
- Ostectomy
- And much more.
Our staff utilizes multiple verified billing and coding solution software to investigate correct billing and coding, such as AAPC (American Academy of Professional Coders), HBMA (Healthcare Business Management Association), GHA Medicare News, MLN Connect, WPS Medicare eNews, and many others sites.
Our medical billing recovery services can utilize a current clinic’s practice management software. MedPro Services, Inc has experience in the following practice management software:
- HealthPac
- Practice Fusion
- Phoenix Ortho
- GE Centricity
- Kareo
- Athena net
- Nextgen
- Open PM
- Modernizing Medicine
- ZirMed
- WebPT
- Intergy
- Medical Manager
- Workflow
If MedPro Services, Inc is not familiar with your practice management software, we will request a brief training session for our staff to understand your billing process.
MedPro Services will assign team members to start working on your Accounts Receivable at the agreed-up dating age. Our team will review unpaid and denied claims. Denied claims will be investigated regarding the denial reason explanation. The most common denials for orthopedic claims are:
Denied for global
- MedPro Services will review the global days from the original surgery. We will review the original operative report regarding the episode of care diagnoses. We will also review the subsequent visit performed during the global period to verify a “new” episode of care was established.
- MedPro will determine through our findings within the patient chart if the subsequent service denial is correct or should be corrected with coding tools and complete the proper appeal.
Pre-operative evaluations and management services are included in the procedure.
- MedPro Services will review the insurance denial regarding the E/M performed on the same day or the previous day and determine if a separate E/M was warranted according to the CMS coding rules.
- We will correct the claim with coding tools and/or complete the proper appeal if warranted.
Bundled Services
- Insurance companies will deny claims if CPT codes are inclusive with a primary CPT. MedPro Services utilizes AAPC’s CCI (Correct Coding Initiative) to verify CMS rules in every state.
- Although some CPT codes are considered bundled with primary CPT codes, we will utilize AAPC’s CCI rules for exceptions.
- MedPro Services will review the patient’s chart to verify that the service that was denied is separate and distinct from another service that would usually be bundled.
- After review of the patient’s chart, we will determine if the documentation supports these circumstances:
- The procedures were performed during different encounters on the same date of service.
- The procedures were performed at different anatomical sites or structures.
- Different physicians in the same group performed the procedures.
- The procedures were unusual circumstances that made this case special, calling for both services to be paid.
- We will use the appropriate modifiers, 59, XE, XP, XS, or XU, to correct a claim when needed.
- Insurance appeals will be generated for claim denials which can be proven payable.
MedPro Services incentives our medical billing staff with a monthly bonus based on captured reimbursement they have personally captured for the client.