Improve Cash Flow with Our Orthopedic Insurance Verification Services

Reduce Claim Denials and Grow your Practice Revenue
  • Verification during appointment scheduling
  • Dedicated manager
  • Flexible pricing with no start-up fees or long-term contracts
  • Optimal blend of technology and human expertise
  • Scalable solutions
Call: (800) 670-2809
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Do what you do best, we’ll do the rest.

Optimize Patient Eligibility Verification and Reduce Denial Rates

Optimize Patient Eligibility Verification and Reduce Denial Rates

Ensuring that your patients’ insurance will cover expensive treatments is critical to avoid potential payment issues later. Coverage and benefit structures vary widely across insurance plans. Most health plans cover medically necessary orthopedic treatments, including office visits, casting, surgeries, hip, spine, and knee surgery. Payers require prior authorization for certain procedures. With these requirements, verifying eligibility for specialized services can be time-consuming.

With Outsource Strategies International (OSI) as your partner, 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.

Improve Your Orthopedic Revenue Cycle with Expert Insurance Verification

Call: (800) 670-2809

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.

Coding

Medical coding and thorough insurance verification work hand-in-hand to ensure proper reimbursement. Our expert coders assign the accurate diagnostic and procedural codes for the orthopedic services provided to each patient. Precise ICD-10 and CPT coding ensures that the claim accurately describes the care delivered, ensuring appropriate insurance coverage and payment.

Authorizations

Insurance companies require prior authorization for joint replacement surgery, spinal surgery, and other types of orthopedic surgery. Prior approval may also be required for diagnostic imaging procedures such as MRI and CT scans. We identify these requirements during eligibility verification and help you submit accurate prior authorization forms and documentation to secure timely approvals.

AR Follow Up

We follow up on unpaid claims, denials, and underpayments on a proactive basis, improving the chance of timely payment. By informing patients about their financial responsibility, our AR follow up can help you improve overall revenue recovery.

Value-added Services That Set Us Apart

The unique benefits of partnering with OSI are:

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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.
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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.

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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.

Orthopedic Insurance Verification Services – Our Pricing Models

Full-time Equivalent Billing (FTE)

In this model, services are billed based on the equivalent cost of a full-time employee (FTE) for a specified duration, which is usually a fixed monthly or annual fee.
The services will be priced based on:

  • The volume of insurance verifications required
  • The complexity of your practice’s payer mix
  • The level of expertise required for the verification tasks
  • The desired turnaround time

FTE/Per Verification Billing

This is a hybrid or blended approach that combines features of both FTE and per-verification pricing. You enjoy the benefits of a fixed-cost FTE arrangement while also having the flexibility to pay per-verification when verification volumes fluctuate.

Per Verification Billing

In this model, you will be charged a set fee for each individual insurance verification performed. You only pay for the services you actually utilize.
Pricing will depend on:

  • The type of verification (e.g. eligibility, benefits, prior authorization)
  • The level of effort involved in each verification
  • The turnaround time
  • The overall volume of verifications performed

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.

Our Patient Insurance Eligibility Verification Process

Patient Insurance Eligibility Verification Process

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

Benefits of Outsourcing Insurance Verification to OSI

  • Dedicated team
  • Stringent QA checks
  • Cost savings of 30-40%
  • Customized reporting
  • HIPAA-compliance
Let our expert team handle the complexities of orthopedic insurance verification!
Call: (800) 670-2809

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.