MAXIMIZING ORTHOPEDIC REVENUE STREAMS
Overcome Orthopedic RCM Challenges with Expert Solutions
Orthopedic practices face distinct patient access and revenue cycle challenges that demand specialized solutions.
The complexity of coding for high-cost surgeries, such as joint replacements and spinal procedures, combined with the frequent need for pre-authorizations, creates significant obstacles. These challenges often result in delayed reimbursements, increased denial rates, and revenue shortfalls.
Many orthopedic providers rely on outdated billing processes or general RCM vendors that don’t account for the intricacies of orthopedic procedures. Key issues like tracking implant usage for reimbursement, managing multiple procedure codes, and ensuring timely pre-authorizations are often neglected, leading to underpayments and revenue leakage. Additionally, the rise in patient financial responsibility requires transparent communication and effective collection strategies to avoid financial strain.
In a thriving orthopedic practice, these challenges are tackled by partnering with an RCM provider experienced in orthopedics. With AI-driven automation and tailored solutions, practices can streamline their revenue cycle, reduce claim denials, improve cash flow, and enhance overall operational efficiency.
OPTIMIZING ORTHOPEDIC PRACTICES
Customized RCM Solutions for Orthopedic Practices
Orthopedic groups know the pain of the payment lifecycle. Whether it's automating patient access processes like prior authorization and eligibility checks, optimizing EHR and billing workflows, or addressing staffing shortages with skilled billing professionals, our tailored approach addresses these common pain points:
Prior Authorization
Insurance Discovery
Eligibility Verification and Benefits Checks
Referral Management and Document Capture
Medical Coding
A/R Recovery and Denials Management
Denials Prevention
Recognized by Industry Analysts and Publications
Powered By Artificial & Human Intelligence
Despite progress AI and automation are making in automating patient access and revenue cycle processes, there remains a need for staff with RCM, clinical and compliance expertise to ensure patients are financially cleared and services rendered are accurately billed and reimbursed.
We provide our clients with complete technology plus team coverage with deep knowledge of the complicated reimbursement landscape.
AI/ML/NLP
Execution
Automation & RPA Execution
Predictive Analytics Insights
HL7/API/RPA EHR Integrations
Payer/TPA Integrations
PRIOR AUTHORIZATION
Ensure timely and accurate orthopedic prior authorizations
Prior authorization is essential for high-cost orthopedic procedures, such as joint replacements, spinal surgeries, and advanced imaging, to avoid claim denials and ensure timely reimbursement.
Key procedures requiring authorization
Joint replacements and spinal surgeries often require prior approval due to the complexity and cost involved. Advanced imaging, such as MRIs and CT scans, needs pre-authorization to ensure coverage.
Handling retroactive authorizations
Retroactive authorizations may be necessary for urgent orthopedic procedures or when insurance details change. Quick submission and accurate documentation are vital to secure approval.
AI-powered workflows
Our prior authorization solution in Patient Access Plus expedites approvals, with specialists stepping in when automated workflows are insufficient.
INSURANCE DISCOVERY
Maximize reimbursements by uncovering hidden insurance coverage
Insurance discovery plays a critical role in identifying all available coverage for orthopedic patients, ensuring no revenue is left on the table.
Identifying secondary or unknown payers
Complex orthopedic procedures often involve multiple coverage layers, and our AI-powered tools identify unknown or secondary insurance.
By uncovering hidden payers, practices avoid missed billing opportunities and maximize reimbursement.
Reducing patient payment burdens
With complete coverage verification, practices can minimize patient out-of-pocket costs.
Reducing financial strain improves patient satisfaction and reduces payment delays.
AI-powered insurance discovery
Our automated platform scans patient records and payer databases to find all available coverage, ensuring comprehensive verification and reducing revenue leakage.
ELIGIBILITY VERIFICATION AND BENEFITS CHECKS
Prevent denials with real-time eligibility verification
Ensuring eligibility and verifying benefits before orthopedic services are rendered is crucial to preventing denials and delays in payment.
Key coverage areas to verify
For procedures like joint replacements and advanced imaging, it’s essential to confirm co-pays, deductibles, and prior authorization requirements.
Verifying specific coverage for implants and post-surgery rehabilitation prevents coverage gaps.
Reducing rejections and disputes
By confirming coverage details upfront, practices can reduce claim denials and prevent disputes with patients over unexpected costs.
Real-time verification
Our AI-powered platform conducts real-time eligibility checks, ensuring all relevant coverage details are confirmed before care is provided.
REFERRAL MANAGEMENT AND DOCUMENT CAPTURE
Streamline referrals and document capture for high-value orthopedic procedures
Efficiently managing referrals and capturing necessary documentation ensures smooth treatment workflows and timely reimbursements.
Ensuring timely referral capture
High-value procedures like joint replacements often require multiple referrals from different specialists. Our system ensures all required documentation is captured and stored correctly to prevent delays.
Improving care coordination
By streamlining referral management, practices can coordinate care efficiently, improving patient satisfaction and reducing administrative burden.
Automated document capture
Our referral management solution automates the capture and storage of all necessary documentation, ensuring compliance and reducing delays in claim submission.
MEDICAL CODING
Achieve coding accuracy for complex orthopedic procedures
Accurate medical coding is essential for ensuring proper reimbursement for complex orthopedic surgeries, such as joint replacements, spinal fusions, and fracture repairs.
Specialized orthopedic coding
Certified coders experienced in orthopedic procedures ensure the correct application of CPT and ICD codes, reducing the risk of claim denials.
High-value procedures like spinal surgeries require precise coding to capture all surgical steps and associated materials, such as implants.
Reducing coding errors
Coding errors can result in underpayments or denials, especially in procedures involving multiple components or implants.
Our expert coders ensure accurate submission, maximizing reimbursement.
AI-powered coding tools
Our AI-powered medical coding tools help automate the process, minimizing errors and speeding up claims submission for high-complexity procedures.
A/R RECOVERY AND DENIALS MANAGEMENT
Improve cash flow with advanced A/R recovery tools
Effective accounts receivable (A/R) management is crucial for maintaining cash flow in orthopedic practices, especially when managing high-value claims.
Prioritizing overdue accounts
Our advanced A/R tools prioritize overdue accounts based on claim value and payer behavior, ensuring timely follow-ups for the highest impact.
By automating follow-ups, practices can ensure more consistent revenue recovery.
Resolving denied claims
Denials related to coding errors, eligibility issues, or documentation gaps can be addressed efficiently with our AI-powered denial management tools.
Timely denial resolution improves cash flow and reduces revenue leakage.
AI-powered recovery insights
Our platform provides real-time analytics on denial trends and payer behavior, helping practices optimize recovery efforts and reduce future denials.
DENIALS PREVENTION
Proactively prevent denials with technology-enabled services
Preventing denials before they happen is crucial for maintaining smooth revenue cycles and reducing administrative burdens in orthopedic practices.
Flagging potential issues early
Our AI-driven technology and expert team identify potential issues—such as missing documentation or improper coding—before claims are submitted, preventing denials.
By addressing these issues upfront, practices can avoid rework and delays in reimbursement.
Addressing root causes of denials
Common causes of denials, such as eligibility gaps or coding inaccuracies, are flagged and corrected, ensuring smoother claims processing.
Our system tracks denial trends, helping practices identify areas for improvement and training.
Automation to ensure compliance
Automated workflows ensure that all payer requirements are met before submission, minimizing the risk of denials and expediting claims processing.
Improve staff workload and patient satisfaction with Patient Access Plus
Our Patient Access Plus platform leverages AI-driven automation to address the unique challenges orthopedic practices face. From managing complex surgical authorizations to streamlining claims for high-value procedures, we help your team work smarter, not harder.
- Boost efficiency with AI-driven automation tailored to orthopedic procedures like joint replacements, spinal surgeries, and arthroscopies, ensuring accurate prior authorizations, eligibility checks, and claim submissions.
- Reduce manual workload by automating tasks such as patient registration, referral management, and benefits verification, particularly for high-cost procedures like ACL repairs, hip and knee replacements, and fracture repairs, allowing your staff to focus on patient care.
- Enhance revenue cycle performance with real-time insights and analytics for tracking implants and surgical materials, optimizing workflows to prevent denials and expedite claims processing for procedures involving surgical hardware and complex surgeries.
- Drive patient satisfaction by providing faster, more accurate service for procedures requiring advanced imaging, orthopedic consultations, and post-operative care, with automated reminders, status updates, and transparent financial estimates.
MAXIMIZING ORTHOPEDIC OUTCOMES
Achieving Superior Financial, Operational, and Clinical Outcomes
Financial
Our clients experience a 20-30% reduction in denied claims, quicker reimbursement cycles, and improved cash flow through advanced billing solutions and denial management.
Operational
Practices report a 25% increase in scheduling efficiency and a significant reduction in pre-authorization wait times, streamlining patient throughput and reducing administrative burdens.
Clinical
By optimizing operations and handling administrative burdens, we allow your clinical team to focus on delivering top-tier patient care, improving patient satisfaction and outcomes.
Discover Hidden Revenue With an RCM Health Check
Receive a comprehensive financial analysis that identifies shortfalls and denial patterns to uncover lost revenue opportunities. Our orthopedic revenue cycle experts will conduct an in-depth audit of your processes, providing insights that can drive substantial improvements in your financial performance.
Reviews
Hear From Our Customers
“I’m just glad that in 2019 we took that step because it opened the door for a really good relationship. Between my team and the Infinx team, we can manage the load…They’re able to turn it around faster than we’re able to turn it around because of some of the automated capabilities that they have.”
Danelle Newman
Patient Access Director
OSS Health
"Since integrating Infinx with our NextGen system, we've seen a massive boost in efficiency. What used to take my team about 3 1/2 minutes per case—manually entering physician information, patient data, insurance details, and clinical notes—now takes less than one minute. The automation has not only saved us time but also significantly increased our productivity. It's been a game changer for us."
Samantha Towler
MRI Patient Services Supervisor
Tennessee Orthopaedic Alliance
