Orthopedic medical billing requires accurate coding, modifier management, global period tracking, implant documentation, and workers’ compensation expertise. MedCare MSO combines AAPC-certified coders and AI-powered workflows to validate claims before submission.
Orthopedic care has completely changed due to advances in the specialty. Starting from joint replacement to outpatient spine surgery, treatments have improved, but at the same time, complexity has increased for the medical billers. Outsourcing to experienced orthopedic billing experts has proven to increase revenue and reduce the administrative strain these high-dollar surgical claims create.
MedCare MSO provides your practice with end-to-end orthopedic billing services covering the coding, billing, denial management, and A/R follow-up. Our team provides billing support for arthroplasty, fracture care, spine procedures, arthroscopy, and complex orthopedic surgical workflows.
Orthopedic billing encompasses various complex procedures, implant handling, guidelines for multiple procedures, rules on global surgery, accuracy in laterality, and workers’ compensation claims. We solve problems that arise as a result of various coding requirements and national rules, thus helping orthopedic clinics prevent refusal of payments, facilitate cash flow, and improve financial results. Such unique competence is what differentiates orthopedic billing companies from regular providers.
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Orthopedic surgeries include a 90-day global period. Routine post-op visits should be billed with the right modifier. Misapplying the -58, -78, or -79 modifier can result in immediate denial. Our orthopedic billing services track every surgery date during the global period, post-op visits are noted, and billable services are on record. This keeps you compliant and reimburses every dollar you owe.
Book A Free ConsultationOrthopedic surgery billing includes some unique elements, such as implant-related issues, modifiers, global period information, laterality accuracy, and workers compensation regulations. Our orthopedic medical billing services assure that these elements are taken into account, which is why generalists miss what specialists notice.
Orthopedic surgical procedures include using joint implants, spinal implantations, and bone grafting types that abide by rules that vary according to the insurance carrier and respective contracts. Incorrect reporting of the orthopedic implants may cause delays in payments, reductions of claims or even denials. We maintain proper documentation, bills, and tracking of the products as required by each specific case.
Global period billing works in a similar way. Fracture care revolves around a 90-day window, while minor procedures are worked around 0 to 10 days, and each window decides which follow-up is bundled. We date every procedure by surgeon and attach modifier 24, 58, 78, or 79 to the encounter that earns it.
Orthopedic practices often lose reimbursement due to incorrect bilateral procedure billing. Modifier 50 and lateral modifiers such as RT and LT should not be confused with one another among the payers as their wrong usage may lead to denial or overpayment and thus a possible audit process. We know how to apply the right modifier depending on the payer.
Sequencing is just as important. Under the multiple procedure payment reduction, under MPPR, Medicare pays the highest-valued procedure at 100% and applies a 50% reduction to each additional procedure. The procedures are ranked by their relative value, and modifier 51 is only used where required taking into account that add-on codes are excluded from this procedure.
Different CPT codes are involved in arthroscopic and open methods. Any confusion about surgical documents can eventually lead coders to pick the wrong one. In order to achieve accuracy, our orthopedic coders examine the medical record and ask the doctor questions rather than making assumptions. Both modifier 22 and claims for expensive implants rely on such documentation.
Workers’ compensation billing requires state-specific fee schedules, authorization workflows, and utilization review compliance. We work across all 50 states and use a longer billing cycle. The same thing can be said about some orthopedic surgeries performed in ASCs, which also require authorizations to be done in advance.
High-value orthopedic claims, including joint replacements and spinal fusions, require detailed documentation to pass payer audits. The highest priority in payer audits is given to joint replacements and multi-level spinal fusions. The completeness of operative notes and documentation of implants is checked first.
Also, necessary out-of-network orthopedic services must comply with the No Surprises Act. Instead of waiting for a request, we collect audit-ready claim packages while building each claim. Work on orthopedic coding compliance becomes a simple matter of providing proof of compliance as needed instead of hoping it will be upheld.
Our services for orthopedic billing span the entire revenue cycle, starting from orthopedic billing and coding to the A/R follow-up. Our expertise stops errors that general experts would miss, automation catches things that mass processing may overlook, and our company combines both aspects to uncover potential problems before they cause any trouble during the denial stage.
Denied claims put your practice at a compliance and revenue risk which compounds with time. Our orthopedic medical billing services are built on validation powered by AI. We validate every claim to identify and remove any errors before submission. This assures that no denial happens and even if a denial occurs, we go straight to the root cause and file a structured appeal quickly to recover revenue.
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I highly recommend MedCare MSO if you are looking for help with your billing and gain some freedom to see more patients or manage your business.
Practice Owner, TXEC
MedCare MSO has been an excellent organization to work with, I highly recommend them for their quality of service and commitment to excellence.
Back Office Manager, STST
We are definitely impressed by the Team’s performance. I worked with a lot of different folks from all over the world on different business transactions, and Mark is truly a top notch talent!
Director of Corporate Development, SC & SF
MedCare MSO’s exceptional communication and expertise elevated our RCM experience and my bank accounts!
Owner, R.D.
MedCare MSO did a great job with our billing and helping clean up old AR. Regular updates and good communication were very appreciated.
Co-Owner, PCP
Chief Operating Officer, MAKO MEDICAL LABORATORIES
Chief Executive Officer, CARE NOW CLINIC
Chief Operations Officer, ION DIAGNOSTICS
Co-Founder, AW Care
Working with MedCare MSO has been a game-changer for my practice. Their expertise in medical billing, AR management, and coding has significantly streamlined our revenue cycle, reduced claim denials, and improved cash flow. The team is proactive, detail-oriented, and always available to address my concerns.
Practice Owner, F&A Clinic
We have experienced tremendous improvements within our billing and claims department that we have entrusted MedCare MSO to manage.
President/CEO, RLT
I am impressed with MedCare MSO’s promptness to respond to any inquiries, with the time they dedicate to reviewing each one of the cases.
Practice Owner/FBH
We update protocols every time CMS releases new rules for CPT and ICD-10 updates. The 2026 CPT set has introduced 288 new codes with significant musculoskeletal changes which our coders implemented on the exact day they were released.
Yes, surely we can. We will integrate our billing platforms with your existing healthcare systems with our AI-powered solutions. This will provide pre-bill validation and our certified professionals will take care of the other orthopedic billing tasks and reduce your denial rates significantly.
Absolutely. We manage complete orthopedic encounters from E/M visits and injections to joint replacements, fracture care, arthroscopy, and spinal surgery. You will get a dedicated team that will take care of CPT coding, modifiers, implant billing, and post-op claims with precision.
There are multiple reasons why. First, you get AAPC-certified coders, payer-specific expertise, denial management workflows, and many other billing solutions. You won’t need an in-house team, instead you can count on our orthopedic medical billing specialists to process clean claims and better reimbursements.
We serve all types of practices, centers, ASCs, clinics, and hospitals, just name it. This means we can manage billing across multiple locations simultaneously by applying correct place-of-service codes, site-specific payer rules, and billing requirements.
Please provide the following information, so our team can connect with you within 12 hours.
Or call us as 800-640-6409
TXEC
I have worked with MedCare MSO for the past eight months, and it has been a great experience. Moses, Mark, Travis, Sebastian, and Tammy have been a pleasure to work with, as well as the rest of the team, including the credentialing folks.
I highly recommend this group and MedCare MSO if you are looking for help with your billing. They will meet with you once a week to review the issues that need to be fixed to improve your payment and capture rate.
If you are looking for help with your billing and gain some freedom to see more patients or manage your business, this is the team you need to work with.
Dr. Jose Correa
Practice Owner
TXEC
STST
MedCare MSO has been an excellent organization to work with. Mark has consistently demonstrated outstanding attention to detail, thorough documentation, and strong professionalism in maintaining accurate records of his findings.
His reliability and dedication have contributed greatly to a positive experience.
I highly recommend MedCare MSO for their quality of service and commitment to excellence. I can’t say enough good things about Mark and his company.
Thank you
Shaunna Mock
Back Office Manager
STST
SC & SF
Hi Ali, I hope this message finds you well. I wanted to give you some feedback on the team.
We are definitely impressed by the Team’s performance. Definitely what we were looking for from switching partners.
In particular Mark Zaiden has been very helpful. In my 5+ years of experience as a M&A Professional, I worked with a lot of different folks from all over the world on different business transactions, and Mark is truly a top notch talent!
Austin has done a great job of leading the communications process and keeping the train going in the right direction. Tammy and some other folks have been key players as well. We really are happy with everyone on the team.
I wanted to pass this feedback along to you as we are really pleased with working with MedCare MSO so far.
Have a great weekend!
Max Owens
Director of Corporate Development
SC & SF
R.D.
MedCare MSO’s exceptional communication and expertise elevated our RCM experience and my bank accounts!
Most helpful is the open/responsive communication of their team with my office and each other, along with the specialty levels of expertise amongst my team for each aspect of RCM.
Kelly Ballou
Owner
R.D.
F&A Clinic
Working with MedCare MSO has been a game-changer for my practice. Their expertise in medical billing, AR management, and coding has significantly streamlined our revenue cycle, reduced claim denials, and improved cash flow. The team is proactive, detail-oriented, and always available to address my concerns.
I would like to take time to recognize two members of MedCare MSO specifically. Moses for his exceptional support and dedication. He is always responsive, and knowledgeable, and goes above and beyond to ensure smooth operations. His professionalism and commitment make a huge difference in our day-to-day workflow. George also for his quick feedback and recognition of what is needed most. He is extremely efficient and always available for clarification and to share his knowledge and expertise.
I highly recommend MedCare MSO to any healthcare provider looking for a reliable and efficient billing partner.
RLT
Hello,
I am writing this email to express our appreciation of the MedCare MSO’s team and all they have done for our business at RLT. In the past year, we have experienced tremendous improvements within our billing and claims department that we have entrusted MedCare MSO to manage. We went from having over $100k in uncollected/billed claims to now reaching near $100k in collection some months.
We are also happy to express our thankfulness that MedCare MSO is now helping us acquire new contracts with different insurance companies. This will in effect benefit everyone involved, allowing us to expand our services and provide more resources for our staff/business partners.
Please note special appreciation for the following:
David Lucas
Mario Ortega
Ambrose William
FBH
I have been a customer of MedCare MSO for one year. They have provided billing and credentialing services for my private behavioral health practice, and I am impressed with their promptness to respond to any inquiries, with the time they dedicate to reviewing each one of the cases, and with their willingness to educate me and my staff about the ever-changing rules of medical billing and the best use of coding. This is a company I Trust with my billing needs.
Dr. Neufeld
Practice Owner
FBH
