Sports Medicine Billing Services
Comprehensive billing and RCM for sports medicine practices, athletic trainers, and rehab centers specialized codes, fewer denials, faster cash.
You fix athletes returning them to play, relieving pain, and rebuilding strength. We fix the paperwork that eats your margin. At Sirius Solutions Global, our sports-medicine specialists know the procedures, injections, imaging flows, and rehab codes that matter and our AI accelerates claim accuracy so your clinicians focus on patients, not denials.
What Sirius Solutions Global delivers sports-medicine tailored RCM
We don’t just submit claims we manage your cashflow and reduce operational friction.
1) Eligibility & benefits verification at point of care
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Real-time checks for patient coverage, surgery authorization needs, imaging pre-auths, and DME benefit limits. Front-end verification prevents a big chunk of denials.
2) Accurate coding & charge capture
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Procedure coding (arthroscopy, injections), correct application of modifiers (25, 59, RT/LT), E/M selection, and therapy unit mapping. We keep a specialist coder on every account to prevent miscoding.
3) AI-augmented claim scrubbing & pre-submission review
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An AI layer analyzes claim fields against payer rules and historical denials, flags risky claims (missing documentation, wrong modifiers), and auto-routes for human review increasing first-pass acceptance.
4) Denial management & appeals
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Root-cause analysis, clinical appeal packages, and trend remediation we don’t just refile, we fix the process causing repeated denials. Trend reporting shows which CPTs, providers, or payers are leaking revenue.
5) Therapy capture & compliance
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PT/OT/AT minute capture workflows; templates and audit trails that support unit claims and defend against audits. We reconcile therapy documentation to billed units weekly.
6) DME & imaging coordination
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Ensure supplier numbers, CLIA/DME provider data, and rental timing are correct; coordinate with imaging vendors to assign the correct POS and provider taxonomy.
7) KPI reporting & regular review cadence
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Weekly dashboards: clean-claim rate, denials by reason, A/R 30/60/90, net collection rate, top CPT deniers. Monthly strategy calls to close gaps.
Outcomes you can expect
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Increase first-pass clean-claim rate (typical improvements vary by baseline; many specialty practices see 10–40% lifts).
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Reduce denial rate through pre-bill scrubbing + targeted appeals.
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Shorten days-in-A/R with prioritized follow-up and AI ranking.
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Recover missed revenue from miscoded procedures, under-captured therapy, and DME issues.
Why sports medicine billing needs a specialist
Sports medicine mixes procedural surgery, injections, imaging, and lots of therapy. A few reasons specialist billing matters:
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Procedure + E/M bundling complexity. Many payers bundle E/M with certain procedures unless modifier 25 or separate documentation supports both services. Getting this wrong reduces payment or triggers denials.
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Therapy unit logic and documentation. PT/OT/ST often operate on unit counts (15-minute increments). Accurate minute capture and correct use of CPT 97110/97112/97140 etc., plus modifiers when needed, are essential to avoid rejections for insufficient documentation.
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High-value procedural variation. Injections (CPTs for corticosteroid, viscosupplementation, PRP), arthroscopy, and surgical aftercare have specific coding nuances (CPTs, modifiers, global periods) that affect reimbursement and postoperative visit billing.
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Imaging and DME overlap. Imaging (X-ray, MRI) and DME (bracing, CPMs) add another billing layer taxonomy, supplier numbering, and proper place-of-service all matter.
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Audit and orthopedic-specific denial drivers. Orthopedic/sports claims are frequently reviewed for medical necessity (surgical indications, conservative therapy attempts) and documentation supporting surgical scope.
Common sports-medicine denial scenarios & how we fix them
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Scenario: Procedure paid but E/M denied (or vice versa).
Fix: We train clinicians to document the separately identifiable E/M elements and apply modifier 25 only where documentation supports an additional service; pre-bill scrub flags claims without sufficient text to justify modifier 25. -
Scenario: Therapy minutes under-captured.
Fix: Point-of-care templates for minute capture, automatic conversion to units (15-minute rule), and weekly audits to reconcile charted minutes to billed units. -
Scenario: Injection or PRP denied for lack of medical necessity.
Fix: Pre-authorization checks, conservative therapy documentation reminders, and clinical justification templates attached to appeals when needed. -
Scenario: Imaging billed with wrong place-of-service / provider taxonomy.
Fix: EDI template validation, front-end checks when ordering imaging, and pre-submission POS validation.
Quick market & competitor snapshot what matters in 2025–2026
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Sports medicine billing sits at the intersection of orthopedics, physical therapy, and imaging meaning practices must capture procedure codes (arthroscopy, injections), evaluation & management (E/M) correctly, and therapy units for PT/OT/SMT. Errors in modifiers, place-of-service, or E/M-to-procedure bundling are common denial triggers.
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The vendor landscape includes niche orthopedic/sports billing vendors and larger RCM firms that now emphasize specialty workflows and AI. Top specialty competitors advertising orthopedic/sports prowess include SpryPT, PGM Billing, Plutus Health, Coronis/Remedy-style firms, and boutique teams like ProMantra and Imagnum Healthcare. These firms compete on clean-claim rates, integration depth, and speed of follow-up.
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AI adoption in RCM is real and material: AI helps with claim scrubbing, predictive denial scoring, automated coding suggestions, and payer rule surveillance all of which reduce manual hours and increase first-pass acceptance. Health systems and vendors report measurable ROI from AI applied to RCM workflows.
Takeaway: To win sports-medicine clients you must show domain coding expertise (arthroscopy, injections, bracing/DME, therapy units), measurable KPIs (clean-claim rate, A/R days), and modern tech (AI scrubs + EHR/LIS/PT system integrations).
How our AI-Powered Billing helps sports medicine practices
You asked for specifics. Here’s how we apply AI to produce measurable benefits:
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Claim risk scoring — ML models analyze historical denials and flag high-risk claims pre-submission. Human coders review only the high-risk set, saving time while reducing denials.
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Automated code suggestions from clinical notes — NLP extracts keywords (e.g., “arthroscopy,” “meniscectomy,” “therapy minutes”) and proposes CPTs/modifiers to speed coder workflow and reduce miscoding.
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Predictive A/R prioritization — AI ranks outstanding accounts by expected recoverable value and probability of success so billers focus on the dollar-impact cases first.
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Dynamic payer rules engine — an automated monitor ingests payer bulletins and updates scrubbing rules so your claims reflect the latest policy without manual lag.
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Denial clustering & root-cause automation — the system groups denials by pattern (same CPT/payer/provider), auto-generates remediation steps, and tracks corrective action until the trend is fixed.
Bottom line: AI reduces repetitive work, surfaces the exceptions, and lets experienced billers apply their judgment where it matters most.
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