Ins and Outs of Increasing Revenue for Your Orthopedic Practice

orthopedic practice management

The 2018 update season has brought some interesting news for orthopedics, from staggering numbers of ICD-10-CM changes to removing TKA code 27447 from the inpatient-only list. The changes are a good reminder (as if you needed one) that there are a lot of factors involved in keeping an orthopedic practice financially sound. Here are some ins (things you can do to improve current systems) and outs (ideas to consider beyond what you currently provide) to think about for 2018.

Make the Most of What You’ve Got

To keep your orthopedic practice healthy, you’ve got to make sure you’re running a tight ship. You can use a revenue cycle management (RCM) review to determine what your areas for improvement are and what changes you should enact. For instance, you may discover that doing a better job of collecting patient information and copays will make a significant financial impact.

Coding: Another area to watch is medical coding. The costs of incorrect coding are wide ranging, including bringing in less than you rightfully deserve, having to do follow-up work to collect for a claim, and facing fines during a payer audit. There are a variety of ways to improve coding, and a combination of tactics will give the best results. For instance, you could perform an audit to determine where the most errors are occurring and then spend the majority of training time where it will have the most impact. You also want to be sure that you have appropriate orthopedic coding resources so your team has the information they need to code correctly, and they have it in a mode that is convenient for daily use.

Appeals: Even if your coding is accurate, you still can expect denials because payers don’t cover every service. But in cases where you think the denial is wrong, don’t ignore your option to appeal. That’s like leaving money on the table. But be strategic about it. Some experts advise that if the reimbursement you can expect from an appealed claim is lower than the cost of the rework required, you may want to consider spending your time on something with a higher return.

Penalties: Sometimes staying financially healthy involves making sure you don’t lose money you’ve already earned. For example, make sure your HIPAA compliance policies and procedures don’t leave you open to fines (and the resulting lack of patient trust, which has costs of its own). And find ways to make programs like MIPS bring in more money instead of resulting in negative payment adjustments.

People skills: Don’t forget that running a successful practice isn’t all about spreadsheets. Creating a positive environment and culture of compliance encourages good team members to stay on board and work as a team.

Think Outside the Box to Find New Opportunities

The answer to your revenue goals may be beyond what you’re currently doing. Depending on your patient population, bringing in a surgeon with a particular subspecialty could make you the go-to practice in your area and beyond. Adding related services is another possible revenue generator for orthopedic practices. For instance, adding imaging or physical therapy services may make sense. Just be sure you’ve got good legal and business support to help your practice understand the implications so you can do everything by the book.

What About You?

In your experience, which choices have helped your practice grow? Which didn’t? Would you do anything different in hindsight?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.


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