Orthopedic Billing & RCM Services That Cut Denials and Speed Cash
Orthopedic practices face some of the most complex billing and revenue cycle challenges in healthcare, as outlined by the American Academy of Orthopaedic Surgeons (AAOS). Our orthopedic billing services and RCM workflows cover every step of the revenue cycle, from prior authorizations to implants and denials. Whether you need complete orthopedic billing and RCM support or targeted denial recovery, Scionis RCM keeps your revenue cycle compliant and profitable.
Scionis RCM builds billing systems that match the actual workflow of your practice. Our team reviews every point of the revenue cycle, closes gaps, and applies the financial discipline required to keep revenue stable. Our orthopedic programs include Spine Surgery Billing, Sports Medicine Billing, Joint Replacement Billing, and Hand Surgery Billing, delivered end-to-end.
Common Orthopedic Billing Mistakes That Erode Revenue
Even well-organized practices lose money from preventable errors:
- Surgeries postponed due to slow or denied prior authorizations
- Assistant surgeon claims denied when modifiers (62, 80, 81) are misapplied
- Left/right errors resulting in full denials or reduced payments
- Injections miscoded or missing drug linkage, lowering reimbursement
- Implant charges lost due to poor reconciliation of OR logs and documentation
- Aged A/R neglected because of fragmented follow-up processes
Our systems are designed to identify and resolve these issues before they reduce revenue.
Our Orthopedic Billing Solutions
Scionis RCM supports orthopedic clinics, ASCs, and MSOs with comprehensive orthopedic billing services, designed for the high-dollar, high-denial risk environment of orthopedics.
- Fracture, Injection & Joint Coding Accuracy
We apply exact CPT codes such as 20610, 20611, 27447, and 27130 with their correct ICD-10 pairs, referencing AMA’s CPT® guidelines. Claims are coded and validated before submission. - Implant Billing Reconciliation
Each OR log, charge sheet, and supply record is reviewed to ensure that screws, anchors, cages, and biologics are included in claims. - Faster, Compliant Prior Authorizations
Our authorization desk achieves approvals in under 48 hours on most cases, reducing last-minute cancellations. - Modifier Precision and Policy Alignment
Codes such as 50, RT/LT, and co-surgeon modifiers are aligned with operative notes and payer policy, following CMS billing and modifier guidelines. This approach prevents unnecessary denials. - Active A/R Management
Every denial is tracked, corrected, and appealed in real time. Each claim is categorized by the root cause, whether modifier, coding, or documentation error. - Clear and Regular Reporting
Weekly dashboards show where delays occur: prior authorizations, coding, submission, or payer response. These reports help administrators focus their efforts.These solutions form the backbone of our orthopedic RCM services, ensuring clean claims and faster cash flow.
Sub-Specialty Expertise
- Spine Surgery Billing Services
- Spine Surgery Billing requires precision in coding levels, instrumentation, and fusions (22612, 22630, 22842, 63030). We match implants with operative notes, apply NCCI edits, and verify documentation so reimbursement is not lost.
- Sports Medicine Billing Services
- Sports Medicine Billing includes arthroscopies and ligament repairs (29827, 29881, 29888). We prevent bundling errors, apply the correct modifiers, and ensure biologics and drug codes are properly linked.
- Joint Replacement Billing Services
- Joint Replacement Billing (27447, 27130, 23472) depends on correct implant reconciliation and global period compliance. Our team audits OR logs against charge masters and verifies global coding rules before submission.
- Hand Surgery Billing Services
- Hand Surgery Billing (64721, fracture care, tendon repairs) is at risk of denial from laterality errors and multiple procedure coding. We apply RT/LT and -59 accurately, validate bundling, and protect reimbursement across simple and complex cases.
Typical Revenue Leaks and Fixes
Case Studies
Spine & Joint Group (Midwest)
- Issue: Frequent implant denials and delayed authorizations in spine and joint replacement cases.
- Approach: Real-time reconciliation of OR logs, pre-bill edit checks for levels and instrumentation, and a fast-track prior authorization desk.
Results:
- 36% reduction in implant-related denials within 90 days
- Authorization approvals reduced from 5+ days to under 48 hours
- $470K recovered annually from previously missed CPT capture
Sports Medicine Practice (Southeast)
- Issue: Repeated bundling denials on arthroscopy claims (29827, 29881).
- Approach: Introduced payer-specific modifier grids and bundling checks before claims submission.
Results:
- Denials reduced by 27% within 60 days
- First-pass clean claim rate improved to 94%+
- Time spent on appeals reduced by 70%
This orthopedic group used our orthopedic billing services / Orthopedic RCM services to cut denials by 36% and strengthen overall RCM performance.
Pricing and Engagement Models
- Percentage of Collections: Performance-based model with no hidden fees.
- Fixed Monthly Fee (Per FTE): Predictable cost structure for larger and small groups.
Why Orthopedic Revenue Requires Specialists
General billing teams often miss critical details in orthopedics
- Inconsistent use of modifiers on bilateral or staged procedures
- Incorrect coding of fracture care due to global period rules
- Injection services underbilled or submitted without drug linkage
- Assistant surgeon claims denied or never appealed
Orthopedic billing requires specialty knowledge and precise execution. Our team applies both.
What Clients Can Expect with Scionis RCM
- 36% reduction in implant-related denials within 90 days
- $470K in annual revenue recovered from missed CPT capture
- Authorization approvals reduced from 5+ days to under 48 hours
- Clean claim rate of 94%+ across Medicare and major commercial payers
Orthopedic Billing/Orthopedic RCM FAQs
- Do you handle sub-specialties like Spine Surgery Billing and Sports Medicine Billing?
Yes. Our teams are segmented by sub-specialty with workflows designed for Spine Surgery Billing, Sports Medicine Billing, Joint Replacement Billing, and Hand Surgery Billing. - How do you reduce assistant surgeon denials?
We use modifiers 80, 81, and 82 only when supported by operative documentation and aligned with payer rules. - Do you bill bilateral procedures differently?
Yes. Modifier 50 or RT/LT is applied with documentation support to ensure full payment. - Which CPT codes generate the most revenue in orthopedics?
Common high-value codes include 27447, 27130, 23472, and 22551. These are closely monitored to prevent denials and underpayments. - How do you make sure implants are reimbursed?
We reconcile OR logs, operative reports, and charge masters before submission. Missed implant charges are identified and corrected at the pre-bill stage.
Request an Audit
Scionis RCM offers a free review of your billing process. Our orthopedic billing services uncover overlooked revenue, recoverable denials, and systemic gaps across spine, sports medicine, joint replacement, and hand surgery.
Scionis RCM | orthopedic RCM services| Built for Orthopedics. Focused on Results.
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Partner with Us to Drive Excellence
Unlock your healthcare organization’s true financial potential with Scionis RCMs. We specialize in streamlining complex revenue processes, recovering lost revenue, and optimizing cash flow. With our expertise, you can focus on delivering exceptional patient care while we enhance your financial efficiency and growth.
Want to work with us?
Partner with Us to Drive Excellence
Unlock your healthcare organization’s true financial potential with Scionis RCMs. We specialize in streamlining complex revenue processes, recovering lost revenue, and optimizing cash flow. With our expertise, you can focus on delivering exceptional patient care while we enhance your financial efficiency and growth.
Our Expertise
