Navigating Old AR and Recovering Denied Orthopedic Claims

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Navigating Old AR and Recovering Denied
Orthopedic Claims
Is your practice struggling with overloaded old
AR and recurrent denied orthopedic claims?
Orthopedic practitioners often find managing
accounts receivable (AR) and recovering denied
claims challengingyet these tasks are essential
for maintaining financial stability. Failing to
manage old AR can severely obstruct your
practices cash flow and operational
inefficiency. Understanding Denied Orthopedic
Claims Denied claims, or claim rejections, occur
when insurance companies refuse to pay for billed
services. Reasons for denied orthopedic claims
range from clerical errors in coding to complex
issues like lack of medical necessity or failure
to meet policy criteria. The American Medical
Association (AMA) estimates that 15 of medical
claims are initially denied, representing a
significant financial drain on healthcare
providers. Denied orthopedic claims directly
contribute to legacy AR, leading to accumulated
unpaid balances that strain cash flow.
Efficiently resolving these denied claims is
crucial to reducing legacy AR and maintaining
financial health.
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Navigating Old AR and Recovering Denied
Orthopedic Claims

• Factors Contributing to Legacy AR in Orthopedic
  Practice
• Inaccurate Orthopedic Billing Mistakes
  in billing can lead to delayed or denied
  payments.
• Denials and Rejections Claims can be denied due
  to various errors or non-compliance with payer
  requirements.
• Patient Responsibility Unpaid patient balances
  can accumulate over time, adding to AR.
• Complex Reimbursement Processes Navigating the
  complicated rules of different payers can be
  challenging.
• 8 Key Strategies for Revenue Recovery from Denied
  Orthopedic Claims in Old AR

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Navigating Old AR and Recovering Denied
Orthopedic Claims
1. Conduct a Thorough AR Analysis A
comprehensive AR analysis is the first step to
understanding the extent and reasons for denied
orthopedic claims. By categorizing and
prioritizing claims based on age and value,
practices can identify the most critical areas
needing immediate attention. This targeted
approach helps focus efforts on the claims that
will yield the highest returns. 2. Improve
Documentation Clear, accurate, and
detailed documentation is vital for the
successful recovery of denied orthopedic.
Orthopedic practices should ensure that all
clinical procedures are thoroughly documented.
This reduces the chances of denials and
strengthens appeals. 3. Train Staff on Denial
Management Investing in staff training on the
latest billing codes, payer policies, and denial
management techniques can significantly reduce
the number of claim denials. Well-trained staff
can accurately code procedures and efficiently
handle the appeals process, increasing the
likelihood of successful claim recovery.
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Navigating Old AR and Recovering Denied
Orthopedic Claims
4. Use Advanced Billing Software Using advanced
billing software with claims scrubbing
capabilities helps to catch errors before claims
are submitted. These tools can flag potential
issues, ensuring that claims are clean and
reducing the chances of denials. Automation in
billing processes can also streamline workflows
and improve efficiency. 5. Implement Real-Time
Eligibility Verification Real-time eligibility
verification helps to confirm patient insurance
coverage and benefits before services are
rendered. This proactive measure can prevent
eligibility-related denials and ensure smoother
claim processing. 6. Develop a Robust Denial
Management Process Establishing a structured
denial management process is essential. This
includes timely follow-up on denied orthopedic
claims, categorizing denials by type, and
identifying patterns. Regular reviews of denial
reasons can help practices adjust their processes
to reduce future denials.
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Navigating Old AR and Recovering Denied
Orthopedic Claims
7. Submit Timely Appeals Submitting appeals
within payer-specific timeframes is crucial for
maximizing the chances of overturning denials.
Practices should maintain a schedule to ensure
that appeals are filed promptly, and backed by
thorough and accurate documentation. 8. Consider
Outsourcing AR Management For many practices,
managing old AR can be time-consuming and
complex. Outsourcing AR management to a
specialized Revenue Cycle Management (RCM) team
can be an effective solution. These experts can
handle the complexities of AR, reducing days in
AR and improving cash flow. Outsourcing allows
orthopedic practices to focus on patient care
while ensuring that their billing processes are
managed efficiently. MBC Can be Your Savior
in Revenue Recovery from Denied Orthopedic Claims
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Navigating Old AR and Recovering Denied
Orthopedic Claims

• Medical Billers and Coders (MBC) offers
  comprehensive billing services that ensure
  compliance with regulations, improve accuracy,
  reduce old AR, and optimize reimbursements. By
  outsourcing to MBC, you can focus more on patient
  care and less on administrative burdens.
• Benefits of Partnering with MBC
• Cost Efficiency Achieve noticeable cost savings
  and a significant 10-15 increase in revenue.
• Streamlined Claims Maximize revenue generation
  through clean claims.
• Optimized Reimbursements Benefit from expertise
  in documentation and coding.

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Navigating Old AR and Recovering Denied
Orthopedic Claims
Dont Let Old AR Dictate Your Orthopedic
Practices Efficiency! Contact Medical Billers
and Coders (MBC) today to enhance your billing
processes, boost reimbursements, and ensure
compliance with orthopedic billing and coding
regulations. Call us at 888-357-3226 or email us
at info_at_medicalbillersandcoders.com FAQs Q
What is denial management in the revenue
cycle? A Denial management involves
understanding each denial, analyzing trends, and
reworking processes to prevent future
denials. Q What are the Key Performance
Indicators (KPIs) to track for effective AR
management? A Critical KPIs for AR management
include the denial rate, days in accounts
receivable (AR), appeal success rate, and clean
claim rate. Q What are the risks of not
addressing old AR promptly? A Not addressing old
AR promptly can lead to financial strain,
compliance risks, patient dissatisfaction,
damaged client relationships, and a damaged
reputation.