Many orthopaedic practices spend far too much time fixing and resubmitting claims that were denied due to errors. Following are 20 steps you can take on a daily, weekly, and monthly basis to submit cleaner claims and get paid faster. These tips will help you reduce accounts receivable days, as well as the time and costs associated with resubmitting claims.

General principles

• Identify one staff member to review all insurance payments for accuracy.
• Review explanations of benefits (EOBs) and Electronic Remittance Advice (ERAs) to address delays, denials, and reductions.
• Analyze the “reason” and “remark” codes on payment adjustments, so you can address them quickly.
• Verify the patient’s insurance eligibility prior to each visit.
• Keep copies of contracted fee schedules and health insurer contracts or store them in the practice management system (PMS).
• Create a plan to upgrade electronic transactions to comply with 5010 and ICD-10 mandated updates before the deadlines.
• Meet with the claims processing team regularly to evaluate workflow for ways to improve efficiency.

On a daily basis

• Submit claims and statements.
• Receive remittance advice files and reports.
• Balance claim files against totals from the PMS.
• Manage primary and secondary rejections, including correcting and resubmitting claims.
• Post remittances in the PMS.
• Read important messages in the message center.

On a weekly basis

• Verify that rejected claims have been corrected and resubmitted.
• Analyze claim rejections to spot and correct common errors.
• Ensure all claims have reached appropriate payers.

On a monthly basis

• Balance claim statistics to create a snapshot of how the office is performing.
• Run a staff productivity report to see how staff is performing over time.
• Compare office performance to industry benchmarks.
• Share news on industry trends and changes with staff.

AAOS Revenue Management Program
To help AAOS members control costs, submit clean claims, and get paid faster, the American Association of Orthopaedic Surgeons (AAOS) offers a revenue management program powered by Gateway EDI. With Gateway EDI, AAOS members will enjoy a low monthly flat fee, guaranteed reduced rejection rate, unlimited customer service by a dedicated AAOS member support representative, and faster payments. The program even includes credit card processing at significantly discounted rates.

If you have questions about the AAOS Revenue Management Program or the discounted rates specially negotiated for AAOS members, or wuld like more details, testimonials, or contact information, simply visit www.gatewayedi.com/aaos

Jerry Winkelmann is Gateway EDI’s dedicated AAOS account representative. Jackie Ryan is manager of the AAOS practice management unit.