Orthopedic billing services for office and surgical workflows
Keep surgical records, office encounters and unpaid claims connected through a defined billing process.
Actigy BPO provides orthopedic billing services for US practices and billing companies that need dedicated operational capacity. The team tracks surgical documentation, reconciles approved charges, prepares claims, posts payments and works denials in existing systems. Your clinicians and coding reviewers retain procedure selection, medical necessity, global-period decisions and final financial approvals.
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For orthopedic groups with several billing handoffs
An orthopedic practice can have office encounters, surgery-related records, equipment claims and rehabilitation activity moving through different queues. The useful outsourcing question is who will reconcile them and resolve the administrative gaps. Actigy BPO is a fit when you want an assigned team in your current systems with a named route back to the surgeon, coding lead and practice manager.
Start with ongoing practice billing, an unresolved surgical-documentation queue or a payer-specific A/R backlog. If your primary need is independent orthopedic coding judgment, qualify that specialist role separately. The orthopedic billing company comparison distinguishes coding-led services from added operating capacity.
Track the evidence needed for each next action
| Billing queue | Administrative work | Decision owner |
|---|---|---|
| Office and surgery reconciliation | Match approved encounter and surgical lists to the billing worklist; identify missing or duplicated entries. | The practice confirms the service, provider and billing entity. |
| Operative documentation | Track the availability of signed notes, supplied procedure details and requested payer attachments. | The clinical team authors and approves the operative record. |
| Authorization mismatches | Compare supplied authorization references with the approved encounter details and route differences. | The authorization and clinical owners resolve scope changes. |
| Laterality and global-period questions | Flag inconsistent source fields and hold uncertain items for the coding reviewer. | The authorized coding owner approves codes, modifiers and global-period treatment. |
| Remittances and appeals | Post approved payment detail; prepare reason-specific follow-up and an evidence packet. | The client approves clinical appeals, contractual interpretations and write-offs. |
For example, an unsigned operative note and a payer's request for additional information are not the same exception. The first needs a clinical-document handoff; the second needs a deadline, a complete approved response and submission evidence. Both remain visible until the responsible owner completes the action.
The CMS Global Surgery booklet explains Medicare's surgical billing framework. The practice's qualified reviewer applies current payer-specific rules. Operators do not select a modifier or override a clinical record simply to release a held claim.
Keep equipment and therapy work connected without mixing claims
Braces, other equipment and rehabilitation may involve separate documentation, billing entities or payer processes. If these are included, the scope identifies their queues and owners rather than silently treating them as part of every surgical claim. Review DME billing services for equipment workflows and physical therapy billing services for visit and authorization tracking.
Your existing EHR, practice management system and clearinghouse remain the working environment. During setup, we test source access, document retrieval, role permissions and the final reporting view. Each location's work can be reported separately while using one agreed exception log and escalation process.
For a contained overdue-claims project, A/R follow-up services define the payer-contact work. For ongoing rejected or denied claims, denial management adds reason-based tracking and approved appeal administration.
Start with a surgical backlog or one practice location
- Reconcile the opening listSeparate new encounters, held surgical claims, denials and older A/R, with balances and filing deadlines.
- Agree the review rulesDocument the clinical, coding and payer-contract owners, plus the evidence needed to release each type of hold.
- Measure completed handoffsReview accepted work and remaining blockers with the practice before expanding the queue.
Track the age of documentation holds, unmatched encounters, posting accuracy and denial reasons by payer and procedure category. Report new submissions separately from recoveries on the opening backlog. The A/R aging worklist and denial cost calculator can help scope workload; the calculator is a planning tool, not a promised recovery result.
Our telehealth RCM case gives a company-reported example of the audit, workflow and measurement method. Its outcomes are not orthopedic results. Use your pilot and proposed staff's relevant experience to assess specialty fit.
Compare the team cost against the same orthopedic scope
Actigy BPO provides a staffing proposal per full-time equivalent (FTE) after reviewing physician count, locations, surgery and office volume, current systems and backlog. The quote identifies administrative billers, review responsibilities, quality assurance and reporting. Coding services, credentialing and equipment billing should be explicitly included or excluded so you can compare proposals fairly.
We provide 24/7 administrative services with rostered handovers. Preparation and posting can run outside clinic hours, while clinical questions and payer calls follow the relevant availability. Teams can be staffed up to 100 people in total; your engagement's staffing, start date and shift coverage are agreed separately.
Before production access, approve the delivery locations, named accounts and escalation permissions using the security overview. The broader medical billing service covers multi-specialty operations when orthopedics is only one part of your organization.
Orthopedic billing services: questions and answers
Can Actigy BPO support both orthopedic office and surgical billing?
Yes, the scope can cover administrative work across office encounters and surgical billing queues. We reconcile the approved source lists, track missing documents, prepare claims under your instructions and follow payer responses. The practice identifies the billing entity and retains clinical, coding and payer-contract decisions. Facility billing is included only when separately agreed.
Who handles global-period and modifier decisions?
Your authorized coding reviewer retains those decisions. The operations team identifies missing or inconsistent source information, gathers the approved record and routes the item with a clear question and deadline. It does not choose a modifier, reinterpret an operative note or assume a service is separately payable to move the claim forward.
Can the team clear an orthopedic surgical documentation backlog?
Yes. A pilot can focus on a defined inventory of held claims. The team records the missing item, responsible clinical or administrative owner, follow-up history and next action. Claims ready for approved submission remain separate from those waiting on clinical completion. Reporting shows both the cleared work and the reasons remaining claims are still held.
Do you also handle DME and physical therapy claims?
These can be scoped as distinct workstreams with their own documentation and review responsibilities. Equipment and therapy activity should not automatically be treated as part of a surgical billing assignment. The audit identifies the relevant supplier or practice entity, systems and approval owners before staffing the additional queue.
How do you protect continuity when changing orthopedic billing providers?
The transition starts with an opening inventory of claims, remittances, filing deadlines and unresolved exceptions. We agree who owns new work and old balances from the handover date, test access and sample the first completed records. Your practice retains system ownership and approval authority. Unresolved items keep their history and assigned reviewer throughout the transition.
What drives the price of orthopedic billing services?
The main inputs are practice size, surgery and office volume, documentation backlog, systems, payer mix and the roles you want to outsource. Actigy BPO quotes staffing per FTE with supervision and coverage defined. Separate clinical coding review, credentialing, equipment billing and legacy A/R when comparing the same scope across providers.
Define the queue you want the team to own
Tell us about locations, office and surgical volume, systems and the claims currently held for missing records. Use workflow descriptions only, without patient data. We will review the workflow before proposing a written scope and paid pilot.
Scope your orthopedic billing pilot
What happens next
Tell us about locations, office and surgical volume, systems and the claims currently held for missing records. Use workflow descriptions only, without patient data.