American Medical Association (AMA) every year releases a new set of Current Procedural Terminology (CPT) and it’s important for orthopedic physicians to stay updated with these coding updates with Medical Billing Software. Most orthopedic physicians have preferred to invest in in-house coding and billing resource that include certified coders and billers with experience in dealing with claims denials and insurance companies.

At Legion Healthcare Solutions (LHS), we understand the changing billing condition of orthopedic physicians; we continuously work with our training team who keeping the coders and billers up to date with changes.

“The new ICD-10-CM code set that came out in 2020 has around 394 changes with 71 deletions, 75 revisions, and 248 new codes.”

– Certified Coder for Orthopedic Medical Billing at LHS

At LHS, over last few years, we have seen the trend that orthopedic physicians have deployed their own team for coding and billing, after some time the rate of denials goes up forcing them to outsource their billing. We understand the underlying the problem with such situations and deploy an onboarding process, where without losing the staff we push your billing into more clearance cycle.”-Billing Manager at LHS

Analyze Claim Denials

One trend observed at many major orthopedic facilities by Legion Healthcare Solutions (LHS) is that denied claims usually have a primary reason for their denials. Most of the denied claims have a common reason for denials, and its been observed up coding has been seen as one of the underlying reasons. Our tech-based analytical solutions analyze the denied claims and give a complete overview to the customer.

Updated Coding for Laterality

LHS observed a major shift in ICD-10 was the inclusion of Laterality. Updated coding for Laterality makes it a compulsion for physicians to code the document right, left, or bilateral depending on different conditions that include fractures and disorders.

Specificity of Injury

Orthopedic practices need to document the specific area of the body. For example, if you are diagnosing a knee injury you will need to cover the specific area of the knee which might be the ligament or femur. LHS understands this requirement by the insurance company, hence during the claims process, we communicate with physicians about the specificity of injury.

Claim Audits

LHS has one of the experienced orthopedic billing audit teams. Orthopedic billing consists of several stages of care and for each coding might be the initial one, subsequent, or sequel. Coding for each of them needs t documented, during our billing audit we contact the physicians to verify many of the details making our billing cycle denial proof.

A certified team of medical coders and billers to function on many entities of orthopedic billing. Legion constantly trains the orthopedic billing team to understand billing and business requirements.

Technology-based solution for the claim process to improve EHR integration into the system.

API-and RPM-based solution to improve patient care service.