Advanced Orthopedic Symposium: You could lose money if you automatically use Medicare rules for private payers

Why This Topic Matters

The article helps practices recognize that applying a single Medicare-based workflow across all payers may affect reimbursement and contract compliance. It also flags common orthopedic billing areas where documentation, patient status, global surgical care, and unlisted procedures require attention.

Article Sections

1. Medicare rules versus private payer contracts

   This section discusses the risk of applying one payer’s rules to all claims and the importance of understanding payer-specific policies. It frames the issue in the context of orthopedic billing and reimbursement.

2. Symposium guidance on office visit documentation and patient status

   This section covers broad documentation topics related to time-based evaluation and management services and patient classification concepts used in office visits. It also addresses the role of non-physician practitioners in those determinations.

3. Global surgical care and related claim issues

   This section addresses preoperative and postoperative care in the surgical global package and the need to align claims with the reported division of services. It discusses claim handling concerns involving outside providers and modifier use in general terms.

4. Inherent surgical approach and separate procedure reporting

   This section discusses the broader concept that some work is considered part of a surgical procedure and should not be reported separately. It also notes additional scrutiny around selected nerve procedures in the orthopedic setting.

5. Unlisted procedure reporting

   This short closing section identifies a procedure for which no distinct code exists and points to use of an unlisted reporting approach.