21+
Years of Experience
98%
Claim Submission Accuracy
25%
Decrease in Outstanding AR
Optimize Patient Eligibility Verification and Reduce Denial Rates
Verification of patient benefits for costly orthopedic treatments can help prevent payment issues later. While most health plans cover office visits, casting, surgeries, hip, spine, and knee surgery, they require prior authorization for certain procedures. With varying benefit structures across plans, verifying eligibility can be time-consuming.
With our efficient partnership, you can ensure that patients’ insurance coverage, benefits, and out-of-pocket responsibilities are verified well in advance of the office visit. Our team has extensive experience working with federal and commercial insurance companies and can ease this front-end process, allowing you to focus on what you do best: delivering quality care.
Comprehensive Medical Billing Services
We provide end-to-end support for medical billing:
Insurance Verifications
We will verify patient coverage and benefits during appointment scheduling. This allows you to calculate service costs and inform patients about their deductibles, coinsurance and copayments. This reduces the risk of surprise bills and improves patient satisfaction.
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Coding
Medical coding and insurance verification work hand-in-hand to ensure proper reimbursement. Our expert coders assign the accurate ICD-10 and CPT codes for orthopedic services. When claims accurately reflect care delivered, it optimizes coverage and reimbursement.
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Authorizations
Payers require prior authorization for certain types of orthopedic surgery and diagnostic imaging procedures such as MRI/CT scans. We identify these requirements and help you submit accurate prior authorization forms and documentation to obtain timely approvals.
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AR Follow Up
We follow up on unpaid claims, denials, and underpayments on a proactive basis, improving the chances of timely and accurate reimbursement. By informing patients about their financial responsibility, our AR follow-up solutions can improve overall revenue recovery.
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Value-added Services That Set Us Apart
The unique benefits of partnering with OSI are:
Live Callers
Besides checking the web portal and existing records, our insurance verification specialists call the payer to confirm patient coverage. This live communication with the payer’s representative ensures detailed, up-to-the-minute information about a patient’s current insurance status, coverage details, and any limitations or preapproval requirements. This is especially important to correctly verify coverage for complex orthopedic surgery.
Open communication
Our team maintains transparent communication and collaboration with insurance companies, expediting verification processes. It also builds rapport and mutual understanding, which can help negotiate potential issues.
EXPERTISE
Our insurance verification specialists have years of experience. They stay up-to-date on coverage criteria, billing and coding policies, and prior authorization requirements of commercial and government payers. This allows you to make relevant changes and optimize your revenue cycle.
We serve all 50 states
Our Patient Insurance Eligibility Verification Process
1
Collecting patient information
Communicating with the patient
4
2
Insurance verification
Requesting prior authorization
5
3
Documentation
Updating the billing system
6
1
Collecting patient information
2
Insurance verification
3
Documentation
4
Communicating with the patient
5
Requesting prior authorization
6
Updating the billing system
Collecting patient information
We collect patient demographics and insurance information when the patient schedules an appointment or arrives for a visit. We make the information easily accessible by setting up a dedicated file for each patient.
Insurance verification
In addition to using an online portal, our team verifies the patient’s coverage status by calling the insurance company. This ensures reliable real-time data on all aspects.
Documentation
The verified details are entered in the patient’s file, making it easily accessible for billing purposes.
Communicating with the patient
We inform patients about the verification results. When they understand their coverage details and financial responsibilities, it helps them plan for their care and reduces the risk of surprise bills.
Requesting prior authorization
We work with you to send prior authorization requests to the insurance company, follow up on the processing, and submit appeals for any denials.
Updating the billing system
The insurance verification and eligibility details are entered in your practice’s billing system.
Benefits of Outsourcing Insurance Verification to OSI
- Dedicated team
- Stringent QA checks
- Cost savings of 30-40%
- Customized reporting
- HIPAA-compliance
Orthopedic Insurance Verification Services – Our Pricing Models
Full-Time Equivalent
In this model, services are billed based on the equivalent cost of a full-time employee (FTE) for a specified duration, usually monthly or annually.
Per Verification Billing
Like an FTE model, a person is dedicated to your practice. Perfect for a practice that is busy. They work as an extension to your business.
FTE/Per Verification Billing
This option is ideal for a practice that is unsure about their work requirements. This can have per request pricing for eligibility and other functions.
AR is only FTE
In this model, you will be charged a fixed monthly or annual fee based on the number of full-time equivalent staff required to manage your practice’s AR follow-up activities. We are also considering a blended model for AR.
FAQs
What orthopedic insurance verification services does your team provide?
Our comprehensive insurance verification services for orthopedic practices include:
- Real-time eligibility checks for patients
- Detailed benefits analysis, including deductibles, co-pays, and coverage limitations
- Obtaining prior authorization approvals from insurers
- Ongoing monitoring of patient insurance status changes
- Denials management and appeals support
- Detailed reporting and analytics
What is the turnaround time for these services?
Our goal is to complete thorough insurance verifications within 24-48 hours of receiving all necessary patient information. We can often provide same-day verification to meet urgent needs.
Can you integrate your orthopedic insurance verification services with our practice management system?
Of course! We have seamless integration capabilities to ensure a smooth workflow and the efficient exchange of patient information between our systems.
What type of reporting and analytics do you provide for orthopedic practices?
Our comprehensive reporting includes insights into verification turnaround times, first-pass claim acceptance rates, denial trends, and other key performance metrics to help optimize revenue cycle management.
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