Increase reimbursements with electronic coding, billing

By J. Brian Gill, MD, MBA

For the last several years, orthopaedic practices have seen professional reimbursements decline while practice expenses increase. According to AAOS census data, private pay insurance in orthopaedic practices declined from 38.7 percent of total revenues to 17.1 percent of total revenues between 1988 and 2004. For the same time period, payments from managed care programs increased from 11.6 percent to 33.8 percent of total revenues and Medicare/Medicaid payments increased from 26.4 percent to 31.2 percent of total revenues. These trends are likely to continue.

In such an environment, orthopaedic surgeons can no longer be complacent about our billings. Increasing overhead expenses and declining reimbursements make it imperative that we code correctly and receive the appropriate reimbursement for the work we do. The fate of our practices depends on our being proactive in coding and billing correctly. But it’s not easy, and sometimes it seems that outside forces are conspiring to make it even more difficult.

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