Navigating orthopedic revenue cycle management can be complex, even for experienced healthcare leaders. Rising costs, evolving regulations, and administrative burdens can be challenging to address.
Identifying the challenges your orthopedic practice faces is the first step. It may take time to correct some of your practice’s unique obstacles. Let’s examine some of the most common orthopedic revenue cycle management challenges.
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1. Managing Costs
Orthopedic practices operate on tight margins, which are complicated by rising overhead costs. An AAOE benchmark survey suggests that most practices spend between 40-60% of their revenue on:
- Facility upkeep and leasing
- Staff salaries
- Insurance necessities
- Technology and computer software
- Specialty services (like x-rays and MRIs)
- Capital expenditures
- Legal costs
Automating administrative duties can help ease revenue cycle management challenges. This method can reduce labor costs and eliminate human errors that may result in compliance issues. Automating tasks enables orthopedic teams to focus on high-value tasks rather than time-consuming paperwork.
For example, you can automate the release of information to reduce record request calls and faxes by approximately 90%.
2. Insurance Denials and Reimbursements
It’s no secret that reimbursement rates from Medicare and private insurers are falling. In 2024, Centene contributed to the highest share of prior authorization requests on the market — with a denial rate of 13.6%.
The Kaiser Family Foundation reported that denied claims for ACA reached as high as 20% on the marketplace the same year.
Your practice may face outright denials regularly. If so, your staff may not have all the necessary patient information they need, increasing claim rejections.
Reviewing your staff training policies to ensure proper prior authorizations and claim submission may help address the issue. It’s wise to keep a thorough record of claims to understand how much denials contribute to your revenue cycle challenges.
3. Updating Office Technology
New products and services for orthopedic practices enter the healthcare market every day, making it hard to keep up.
Areas to consider when looking for new solutions include:
- EHR Integration: Solutions that integrate directly with your existing systems can improve your operational efficiency. For example, ChartRequest offers full integration with athenahealth, Raintree, and ModMed, with more integrations coming soon.
- Patient Empowerment: These tools streamline patient access to medical records, which empowers them to take a more active role in their healthcare. A strong reputation can attract new patients and contribute to total revenue.
- Security Tools: You can address potential threats by using the most secure tools and systems. These protections will protect your business from costly HIPAA fines and legal penalties.
As your practice grows, investing in the right technology supports long-term success. Whether you’re focused on boosting patient satisfaction, improving internal workflows, or reducing compliance risks, modernizing your tech stack can help your team work smarter, not harder.
4. Employee Retention Rates
Employee turnover can significantly disrupt the revenue cycle by increasing staffing costs and impacting patient care.
40-60% of orthopedic surgeons experience burnout. This mental health problem contributes to high turnover in the workplace.
Losing employees won’t save your practice money. Recruitment, salary and benefits, and training can cost practices like yours $200,000 or more.
Follow best practices to improve your workplace environment for staff and patients. Allow doctors time to enjoy a work-life balance, offer incentives and holidays, and encourage transparency. These methods will improve morale in your practice and encourage orthopedic doctors to stay with your organization.
5. Record Exchange Communication
Poor communication during record requests can eat into your annual revenue. HIPAA requires your staff to respond to patient record requests within 30 days.
Failure to comply with HIPAA may result in fines reaching up to $68,928 per violation, with annual maximums exceeding $2 million per violation category.
Improving turnaround times for record exchange doesn’t require a major investment. Using a third-party service can improve transparency and help your team reduce lengthy follow-up calls.
ChartRequest provides white-glove support to your entire requestor community. We offer real-time status updates online so requestors can track progress without follow-up calls.
Additionally, our 5-day turnaround time guarantee ensures fast record delivery every time.
Ease Orthopedic Revenue Cycle Management Challenges With ChartRequest
Don’t let orthopedic revenue cycle management challenges prevent you from growing your practice. ChartRequest can help you stay competitive in this expensive industry.
ChartRequestSelect is a no-cost release of information service for orthopedic practices.
