Orthopedic revenue cycle management (RCM) is critical for the financial health and operational efficiency of independent orthopedic practices. Navigating the complexities of orthopedic RCM presents unique challenges, from managing patient billing and insurance claims to handling regulatory compliance and reimbursement processes. These obstacles can overwhelm in-house teams, leading to inefficiencies and potential revenue losses. However, by finding the right expert RCM partner who specializes in orthopedics, practices can optimize their revenue cycle while focusing on patient care.
According to Equifax, poor billing practices result in doctors in the US losing approximately $125 billion per year, or an average of about $5 million per provider.
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Top Challenges for Orthopedic Revenue Cycle Management
Evolving Requirements
Navigating the maze of regulatory requirements is a significant challenge in revenue cycle management for busy orthopedic practices. Since practices must consistently comply with changing healthcare regulations and ongoing updates from payers, they need dedicated personnel or systems that monitor and implement these changes. Failure to meet these requirements can lead to delayed payments or even fines. Staying current with these regulations consumes valuable time and resources, especially for already strained practices, and detracts from patient care.
The industry standard is typically one full-time biller for every 10,000 claims processed annually, resulting in an average of 2.7 billing employees per physician.
Navigating Reimbursement
Ensuring accurate and timely reimbursement from payers is a central part of orthopedic RCM, but it has become increasingly complicated. Varying payer policies, coding requirements, and fee schedules create a convoluted web of things to manage. Billing mistakes can lead to denials and underpayments – impacting a practice’s revenue. Practices must invest significantly in staff, training, and software resources to handle reimbursement, which can seem like unrealistic expenses for small or medium-sized businesses.
Up to 80% of medical bills contain errors or overcharges in the US.
Managing Prior Authorizations
Managing prior authorizations is a common hurdle in orthopedic revenue cycle management. Getting that pre-approval can be time-consuming and complex, often involving multiple steps and stringent documentation requirements. Delays or errors in handling prior authorizations can lead to denied claims and delayed payments, impacting the practice’s cash flow. To streamline this process, orthopedic practices must establish an efficient system for tracking and managing these authorizations. However, maintaining such a system requires significant administrative resources, which can be challenging for smaller practices.
Prior authorizations account for approximately $35 billion of total healthcare administrative spending in the US.
Start Strong with a Trusted RCM Partner
A robust orthopedic RCM process begins with patient scheduling, setting the tone for accurate data capture, insurance verification, and authorization management. However, today’s healthcare landscape makes handling these tasks in-house increasingly difficult. An expert orthopedic RCM partner can relieve this administrative burden, allowing practices to focus on delivering exceptional patient care.
We recommend finding an expert revenue cycle management partner who employs a team of billing professionals who specialize in working with orthopedic practices. The right partner will be able to provide you with specialty-specific expertise and insights that will not only keep your orthopedic RCM operations running smoothly but also improve them. It is easier for an RCM partner to stay current with the latest requirements and invest in the latest technology solutions so you don’t have to.
Ultimately, the right RCM partner doesn’t just handle billing—they streamline the entire revenue cycle process, from the initial appointment to final reimbursement. They invest in the latest technology, keep up with regulatory updates, and provide specialty-specific expertise to optimize revenue flow.
The right orthopedic revenue cycle management partner will have specialty-specific expertise that not only streamlines billing processes, but helps optimize them for improved revenue flows.
What to Look for in an RCM Provider
While plenty of RCM service providers are out there, not all are equal. At the very least, your partner should be able to provide custom financial management solutions and plans to make tracking cash flow through your practice easy. They should also provide strategic support and specialty-specific consulting services to help with business planning, especially in the constantly evolving healthcare landscape.
In the end, picking the wrong partner could cost you more in time, money, and other resources than it saves you. At the very least, we recommend an RCM partner who offers a fully integrated process, including:
- Prior Authorization Management: The right RCM partner will support proper authorization management to ensure that insurance approval is acquired before proceeding with treatment. Ensuring accurate claim submissions is essential to prevent denials and revenue loss for practices. Partnering with an orthopedic RCM expert ensures improved automation management, which improves cash flow, avoids penalties, and keeps overall practice operations running smoothly.
- Dashboards and reporting: Your RCM partner should be 100% transparent with all the financial aspects of your practice – this means giving you easy at-a-glance tools and dashboards to track cash flow. At the very least, these custom reports should include real-time data, claims tracking, denial and rejection analytics, and data visualization.
- Actionable insights and best practice recommendations: Your RCM partner should provide your team with actionable insights and tailored feedback to improve charge capture and patient flow, ultimately maximizing revenue. You should also have access to real-time insights into cash flow and claims tracking through user-friendly tools.
Not all orthopedic revenue cycle management service providers are created equal. Be sure to look for a partner with specialty-specific expertise to support your practices' unique needs.
TRIARQ Health: Your Modern Orthopedic RCM Partner
At TRIARQ, our orthopedic RCM services include everything above – and more. Instead of just billing services or software, we take a unique approach to bridge the gap between business operations and cash flows. Our strategic expertise ensures that you have efficient and effective RCM processes that provide correct and timely payment.
We combine strategic expertise with leading technology and back it with operational efficiencies to improve and optimize your orthopedic revenue cycle management processes.