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We offer complete orthopedic revenue cycle management services, as well as tailored services from before the patient steps into the clinic to final payment collection. Our experienced staff follow your protocols and work within your business hours.
Coverage is confirmed before every appointment, including plan benefits, surgical authorization requirements, implant coverage limits, and out-of-network flags. Eligibility gaps caught before the visit don't become denied claims after it.
DrCatalyst's team manages prior authorization for joint replacements, spinal surgeries, advanced imaging, and high-cost implants. We track submissions through approval, open requests in real time, and escalate proactively when payers delay.
Our team manages inbound and outbound referrals, tracks authorizations for referred services, confirms the completeness of referrals before patient appointments, and follows up on pending referrals to prevent delays in care.
Phone support for patient pre-registration, insurance verification calls, appointment scheduling, referral intake, and answering billing inquiries, all handled by orthopedic specialty-trained staff.
Our team proactively monitors all global surgical periods, including the 10- and 90-day postoperative windows. We ensure services performed during these periods are accurately coded, supported with appropriate modifiers, and billed in compliance with payer guidelines to minimize denials and reduce audit risk.
Every orthopedic claim denial is analyzed for modifier conflicts, documentation gaps in medical necessity, prior authorization failures, or bundling errors. These root causes are corrected and resubmitted with the clinical support required to overturn them.
Our certified orthopedic coders handle the full spectrum from office E/M visits and diagnostic injections to complex surgical cases, fracture care, joint replacements, and multi-level spinal procedures.
We review dashboards covering denial rates by payer, clean claim rates, A/R aging, implant charge-capture accuracy, and surgical billing to maintain the high performance of your orthopedic practice.
Aging orthopedic claims are processed systematically at 30-, 60-, and 90-day thresholds. Every uncollected balance receives a documented follow-up attempt before it's considered for write-off.
We manage the full credentialing and re-credentialing lifecycle for the orthopedic surgeons and therapists. This includes hospital affiliations, ASC enrollments, payer panel applications, CAQH updates, and group linking.
Our skilled orthopedic coders review every multi-procedure claim against NCCI edit tables and payer-specific modifier policies before submission for accuracy.
We process 40,000+ prior authorization tasks per month across all specialties. Our orthopedic prior authorization team knows payer-specific criteria for surgical necessity, implant coverage thresholds, and escalation paths for peer-to-peer reviews.
Our orthopedic credentialing services track each provider's credentialing renewal timeline to proactively initiate re-credentialing. We also support contract renegotiation to align payer terms and rates with current credentialing status.
DrCatalyst conducts orthopedic coding audits to review operative reports against submitted claims, identifying missed charges, unbilled add-on codes, and underdocumented complexity levels that should have supported a higher reimbursement.
Our team identifies what payers look for in operative notes and pre-authorization clinical summaries to ensure documentation standards that protect both clinical and billing integrity.
Our orthopedic billing specialists audit surgical charge sheets against operative reports to ensure that the implants, supplies, and materials used are documented, coded, and billed with HCPCS codes where applicable.
We give your business the edge with unmatched features working seamlessly together, delivering precision and efficiency like no one else.
Written protocols Liability Insurance 3+ Levels of Supervision 5 point IT protection HIPAA BAA included Comprehensive reports & KPIs 3rd party HIPAA compliance certification
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