Orthopedic Billing Services
AI-Powered RCM for Bone & Joint Care
Customized for orthopedic surgeons, sports medicine experts, and musculoskeletal clinics, Sirius Solutions Global specializes in orthopedic medical billing services. Because orthopedics combines high-value treatments, complicated coding, and several payer regulations, exact billing is absolutely vital for sustaining a good revenue cycle. Reduce denials, expedite reimbursements, and keep your practice completely HIPAA, CMS, and payer compliant by using our AI-driven orthopedic billing solutions that mix specialty-specific coding expertise with cutting-edge RCM technology.
Our Comprehensive Orthopedic Billing Services
1. Control of the revenue cycle from start to finish.
From patient eligibility confirmation to payment posting and denial resolution, we handle the whole revenue cycle with 100% openness.
2. AI-Powered Coding Precision
Our orthopedic-certified coders and AI-aided coding system guarantee correct CPT, ICD-10, and HCPCS code allocations for:
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Management of fractures
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Arthroscopic operations
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Replacement of knees
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Surgical procedures on the spine
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Methods for sports injury care
3. Billing Under Global Surgical Package
We monitor and control bundled surgical payments to guarantee accurate billing for preop, intraop, and postop care.
4. DME: Billing for Durable Medical Equipment
Orthopedic treatments usually include supports, orthotics, and braces. Fast reimbursement comes from our management of DME coding, documentation, and prior authorization.
5. Billing for Injectables and Imaging
We guarantee adherence to payer-specific regulations by optimizing billing for X-rays, MRIs, CT scans, and intra-articular injections.
6. Recovery and Denial Prevention
Predictive analytics and real-time claim scrubbing enable us to avoid most denials before they arise and to recoup lost money from unpaid claims.
Benefits of Partnering with Sirius Solutions Global
✅ 98% Clean Claim Rate – Fewer denials and faster payments
✅ 30% Faster Turnaround Time – Optimized submission and follow-up processes
✅ Increased Collections – Minimized revenue leakage through proactive billing
✅ Orthopedic Coding Specialists – In-depth knowledge of musculoskeletal care billing
✅ Dedicated Account Manager – Personalized support for your practice
Why Orthopedic Billing Requires Specialty Expertise
Orthopedic billing is more complicated than regular medical billing due to:
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Multiple surgical procedure codes and modifier combinations
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Bundled payment standards for postop visits and fracture care
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Injection techniques needing advance clearance and high-value imaging
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Pricing for braces, supports, and implants under durable medical equipment (DME)
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Worldwide surgical package administration to avoid underpayments
Orthopedic clinics run higher denial rates, revenue leakage, and compliance hazards without specialized expertise.
Global surgery periods & modifier
Modifiers and global periods are frequent sources of confusion in orthopedics. Practical rules we use every day:
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Modifier 78 — unplanned return to the OR for complications of the original procedure (use per CMS global surgery guidance).
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Modifier 79 — unrelated procedure by the same provider during the postoperative period.
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Modifier 57 — decision for surgery on the day of an E/M (major procedure).
We tie each modifier to a documented clinical rationale in the chart and include a short coder/physician checklist to defend the modifier on appeal if needed. (See CMS global surgery documentation for specific examples.)
Top orthopedic denials we fix and the exact operational fix
1. Implant/device missing or incomplete → Fix: implant capture at OR, upload manufacturer device info and include UDI/lot when required; hold claim until validated.
2. Modifier misuse / bundling errors → Fix: pre-bill modifier rules engine plus a manual coder review for edge cases (return to OR, unrelated procedures, same-day E/M).
3. Medical-necessity denials for TKA/THA (LCD challenges) → Fix: attach pre-op documentation, conservative therapy history, and imaging reports per LCD requirements.
4. Incorrect units for arthroscopy/EMG-like counting errors → Fix: charge capture audits and EHR-to-billing reconciliations that reconcile OR time, laterality and units.
Quick publish line: “We don’t just file appeals — we stop repeat denials by fixing root causes and updating your charge rules so the same error doesn’t reappear.”
Technology-Driven Orthopedic Billing Advantages
We use human knowledge together with current billing systems to give orthopedic clinics a competitive edge:
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Using AIPowered Claim Scrubbing, it finds and fixes coding errors before submission.
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From any time, any place, get billing dashboards.
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More Epic, Athenahealth, Allscripts, eClinicalWorks, and other integrations of EHR/EMR assist.
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Through automated prior permission, it lowers approval delays for costly orthopedic treatments.
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Predictive analysis projects cash flow, payer performance, and seasonal patient patterns.
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256-bit encryption protects financial and patient data under HIPAA compliance.
Why Orthopedic Billing is Different
The range of injury treatments, sophisticated imaging methods, and particular rehabilitation programs included in sports medicine billing calls for a different approach. We offer AI-powered sports medicine billing solutions at Sirius Solutions Global with unmatched accuracy for anything from arthroscopic procedures to injection therapy billing. To hasten payments and avoid revenue loss, our specialists make sure that modifiers are appropriately utilized, eligibility checks are carried out in real time, and payer rules are followed. We assist you in maximizing reimbursements and maintaining your cash flow whether you operate a sports injury center or are connected to an orthopedic clinic.
Implant tracking, prostheses & UDIs — why it matters
Payers increasingly require prosthesis reporting, UDIs and lot/serial numbers for implantable devices — missing or incomplete device details commonly trigger audit requests and payment delays. We capture implant data at the point of care, attach required device documentation to claims when needed, and run a prosthesis validation step before submission to prevent avoidable denials and recoupments. For Medicare-specific prosthesis billing instructions, follow your MAC guidance and implant billing instructions.
Strengthen Your Orthopedic Practice’s Financial Health
Orthopedic procedures involve high patient demand and highly valued treatments, so we are aware of these at Sirius Solutions Global. Designed to maximize reimbursements, minimize denials, and maintain your predictable revenue, with our AI-powered orthopedic billing solutions.
📞 Get a free orthopedic billing analysis today and learn how we may help your practice prosper financially as you concentrate on restoring mobility and enhancing patient lives.