BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM CARC
🟢 Orthopedic Services
Specialized Orthopedic Billing Services for High-Volume Practices
Precision Coding, Faster Reimbursements, and Seamless Financial Workflows
Schedule a Call21 Days
Average Time to Submit Post-Surgery Claims
19%
Work Comp & Auto Injury Claim Delays
$7.8M
Total Collections from Payers & Patients
Overview
Why Orthopedic‐Focused RCM Matters
ASP-RCM Solutions specializes in orthopedic billing, ensuring correct CPT/ICD-10 codes for procedures like PLC reconstruction, arthroscopy, and implant removal, using HIPAA-compliant workflows, EHR integration, and NCCI edit checks
Scalable Solutions for Orthopedic Facilities
We provide an adaptable model for orthopedic clinics of all sizes. Whether you handle knee and hip replacements, foot and ankle surgeries, or spinal procedures, our certified orthopedic coders ensure accurate coding and thorough documentation. By leveraging ICD‐10 expertise and modifier accuracy, we help you avoid costly denials, reduce administrative overhead, and boost financial returns
End‐to‐End RCM and AR Management
Our approach covers every aspect of accounts receivable management, from patient enrollment and verification to EOB reconciliation and daily denial follow‐up. We run frequent audit checks, deliver short‐ and long‐term financial planning reports, and use real‐time analytics to highlight areas for process improvement—keeping your practice in a healthy financial state
Effective and Fast Medical Invoicing Services
Speed and accuracy are vital for orthopedic claims. Using AAPC‐certified coders with extensive knowledge of CPT and HCPCS guidelines, we ensure timely, error‐free submission. From 23333 (removal of foreign body from shoulder) to 24165 (prosthesis removal with debridement), our team handles complex ortho codes to maximize reimbursements
Personalized, Transparent, and Boutique‐Level Billing
Your practice isn’t one‐size‐fits‐all, and neither are our solutions. We provide on‐demand data access, fully customizable reporting, and streamlined claims procedures that integrate seamlessly with your existing EMR and practice management (PM) systems. Our emphasis on accurate documentation and modifier usage results in higher clean claim rates and minimal denials
Orthopedic Billing and Coding: Using Best Practices
We handle everything from pain pump insertions and arthroscopies to oncology in orthopedics. By employing licensed coders trained in E/M and surgical coding for orthopedics, we catch potential issues—such as improper modifier usage—before claims are submitted. This proactive strategy reduces rejections and ensures maximum insurance reimbursements
Operations
Core Operational Framework for Orthopedic Practices
We combine technical expertise, rigorous HIPAA compliance, and advanced RCM software to optimize your entire billing cycle. Below are the major operational areas we focus on to keep your revenue flow strong and uninterrupted
Front‐End Patient Verification and Eligibility
Automated eligibility checks at the time of scheduling help identify out‐of‐network patients and deliver real‐time E/M coding alerts. By catching issues early, we eliminate claim rework and speed up the billing cycle
Dedicated Orthopedic Coding and Audit
Our specialized team performs regular documentation audits to align with CMS guidelines and NCCI edits. Using MUE checks and advanced coding software, we accurately apply the right modifiers for procedures like rotator cuff repair or arthroplasty, ensuring compliance and optimal reimbursement
Denial Management and Proactive Alerts
We offer proactive denial alerts and real‐time claim tracking to tackle rejections swiftly. Each denial is categorized, analyzed, and addressed—often preventing similar issues in future billing cycles. This targeted approach significantly decreases your denial rate and accelerates AR recovery
Comprehensive Reporting and Data Transparency
Access to on‐demand, customizable dashboards lets you monitor KPI metrics like days in AR, claim aging, and reimbursement trends. With these insights, you can quickly make informed decisions about resource allocation, contract negotiations, and practice growth
Advanced Claims Handling: HCFA/UB/WC/NF
We handle diverse claim types—HCFA, UB, workers’ comp (WC), and no‐fault (NF)—ensuring correct formats and code sets are used for each payer. Our billing software integrates with your PACS interface if needed, and we also handle attorney management and additional services like hands‐free transcription
Guaranteed Revenue Uplift and EOB Reconciliation
We promise a noticeable increase in revenue within 90 days, typically 10%–20% or more, by optimizing your clean claim submission and workflow efficiencies. Our near‐instant EOB reconciliation process ensures you’re paid accurately and promptly keeping your practice’s cash flow healthy while reducing administrative burdens
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have safely received your patient and encounter data, we code, review, and send claims to payers. We also manage appeals and denials, track payments, and provide frequent updates. Our procedure is designed to be effective and open.
Our qualified coders and billing specialists evaluate every claim stringently. We employ quality control procedures, coding audits, and cross-referencing with payer requirements to guarantee accuracy and lower the possibility of denials.
Our denial management team examines every refused claim to identify the underlying reason. We quickly fix any problems and submit claims again, and where needed, we collaborate with payers on appeals to ensure you get the most money back.
Our pricing policy is adaptable and customized to meet every customer's demands. Usually, we charge a set fee based on volume or a portion of collections. Contact us for a quote tailored to your clinic's particular needs.
Indeed. Our specialty is smooth transfers from internal procedures or other billing businesses. To guarantee that all data is moved safely, our staff will collaborate closely with you and offer training as required.
Resources
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