Orthopedic Billing and Coding Services

Orthos is a U.S.-based orthopedic revenue cycle company providing specialized orthopedic medical coding, billing, and accounts receivable management for independent orthopedic practices and surgery centers. Orthopedics is the only specialty we serve at scale.

Where orthopedic billing loses money

Most billing companies can submit an office visit competently. Orthopedic revenue breaks further in than that. A second procedure in the same operative session was genuinely separate work and nobody documented or reported it that way. Or it was never separately payable, got billed as though it was, and pays at first before being taken back. An injection or a brace goes out without the prior authorization the payer quietly requires. A payer reimburses below the contracted rate with nobody checking.

Some of that comes back as a denial. Most never surfaces, which is how a practice can look healthy on a billing dashboard and still be underperforming. Clean-claim rate, the number most billing companies lead with, only measures whether payers accepted what was sent. It cannot show you a claim that was accepted, paid, and still worth less than the work behind it.

Post-operative global periods are the same story at higher volume. Routine follow-up is already paid for inside the surgical fee, so the exposure sits at the edges. Visits that were genuinely unrelated and separately billable never got billed that way. Then there are return trips to the operating room, where planned, complication-related, and unrelated cases each pay differently, and visits billed inside the window that a payer takes back six months later. We handle a very large volume of this work and we are excellent at it. Vendors who make global periods sound mysterious usually are not doing many of them.

None of this means generalist billing companies are careless. Orthopedics is genuinely hard to bill, payer rules move without much warning, and a team splitting attention across forty specialties cannot stay current on all of them.

Who works your claims

Orthos is based in South Bend, Indiana. Our coders, billers, AR specialists, and prior authorization staff are our own employees.

Orthopedics is the only specialty we staff for at scale. The same payers, the same denial reasons, and the same handful of judgment calls come up constantly, so the person handling your claim has usually dealt with the situation before. Our leadership team brings more than twenty years in orthopedic revenue cycle between them.

What we handle

Partial or full outsourcing. Some groups hand us the entire revenue cycle; others keep front-desk and patient-facing work in house and give us the claims.

Surgical charge capture

Turning the operative note into a complete claim, with every billable component on it. Secondary procedures and separately payable grafts get lost here, and once a claim goes out short nobody notices.

Modifiers

Distinct-service, laterality, staged and unrelated-procedure, and multiple-procedure decisions. Modifiers are where correctly performed work most often gets paid wrong, and the result can be a denial, a short payment, or a recoupment a year later.

Credentialing and payer enrollment

Getting providers enrolled, handling revalidations, and keeping effective dates from lapsing. A credentialing gap is usually discovered a month after it started.

Accounts receivable and old AR cleanup

Ongoing AR follow-up, plus one-time projects on aged receivables, including backlogs left behind by a prior vendor or a departed biller.

Implants, grafts, and DME

Grafts, injectables, braces, and orthotics: what is separately payable, what the plan carves out to its own DME vendor, and what the patient owes because the payer calls it investigational. Implants are packaged into the facility payment rather than paid on the physician claim, and we bill the surgery center side as well.

Orthopedic medical coding

ICD-10 and CPT coding for surgical and office encounters, available on its own or as part of full billing.

Denial management and surgical appeals

Working denials until they pay or are genuinely dead. Surgical appeals go out with the documentation payers respond to, which usually means the operative note.

Workers' compensation and personal injury

A meaningful share of orthopedic revenue arrives through workers' compensation, auto, and personal injury claims, and very little of it behaves like commercial insurance: state fee schedules, authorization secured case by case, adjuster correspondence, attorney and lien handling, and AR cycles measured in months rather than weeks. Practices let this age because it does not fit the normal follow-up routine, and it is often the oldest money on the books.

Global period and post-operative visits

Tracking the window that follows every procedure, zero, ten, or ninety days depending on the code, and determining whether each subsequent visit is included in the surgical payment or separately billable with the right modifier. Included visits still get reported.

Prior authorization

Injections, advanced imaging, surgical procedures, and DME. Requirements vary by payer and change without much notice, which is most of the work.

Underpayment and contract variance

Comparing what payers actually paid against what your contracts say they owe. Underpayments are quieter than denials and go unnoticed for years. We have found more than a hundred significant ones for our clients.

Patient balances and payment posting

Statements, patient calls, collections escalation, posting, and reconciliation.