# Orthopedics Case Study

> See how WeBill Health defended revenue for an orthopedic practice by neutralizing bundling denials and modifier errors before submission.

Source: https://webillhealth.com/case-studies/orthopedics/  
Publisher: WeBill Health  
Last updated: October 27, 2026

Case study · Orthopedics

## $300K more in annualized collections for a 5 provider orthopedic practice

Denials were running at 13% and $285K sat in A/R past 90 days. Patients were paying only 75% of what they owed. Ninety days after WeBill Health took over the revenue cycle, every one of those numbers had moved.

5 providers$2M annual collections beforeResults measured at day 90

**+$25K**Monthly collections, from $166.7K to $191.7K

**4.8%**Denial rate, down from 13%

**$145K**Cleared from A/R over 90 days

**90%**Patient balances collected, up from 75%

The practice

## Care was delivered. Payment was not keeping up.

A five provider orthopedic group with surgeries, injections and follow up visits all moving through global periods and payer edits. The largest claims were the ones most likely to stall.

| Specialty | Orthopedics |
|---|---|
| Providers | 5 |
| Annual collections | $2M, about $166.7K a month |

What we found in the audit

### 13% of claims denied

Too many claims came back unpaid, with the same denials repeating month after month.

### $285K stuck past 90 days

Earned money was sitting in aging A/R with no one working it by payer or by filing deadline.

### 91% clean claim rate

Too many claims needed rework before a payer would even process them.

### 75% of patient balances collected

Copays and balances were left behind at checkout and never recovered.

What WeBill Health changed

## Six fixes before the visit, in the coding and after submission

Every claim received human pre submission review by orthopedic coding experts, checked against our payer rule libraries for each carrier this practice bills.

Before the procedure

### Authorize and verify first

* Prior authorization secured for surgery and advanced imaging
* Eligibility verified and patient balances collected before the procedure

Coding

### Respect global periods and payer edits

* Global period review so visits inside a surgical global are billed only when separately payable
* Procedure coding checked against payer edits and modifier rules before submission

After submission

### Collect the high dollar claims

* Underpayments identified against contracted rates
* High dollar A/R worked first, by payer and by age

90 day results

## Before and after WeBill Health

### Denial rate

Lower is better

Before**13%

After**4.8%

### Clean claim rate

Higher is better

Before**91%

After**98%

### A/R over 90 days

Lower is better

Before**$285K

After**$140K

### Patient balances collected

Higher is better

Before**75%

After**90%

### Monthly collections

Higher is better

Before**$166.7K

After**$191.7K

Every bar starts at zero. Figures come from the practice’s own billing reports, comparing the baseline month with month three.

Where the $300K comes from

## An extra $25K collected every month

Monthly collections rose from $166.7K to $191.7K by day 90. Held for a full year, that is $300K the practice collects on care it was already delivering.

The gain came from specialty specific coding and fewer days in A/R. Fewer claims were denied, and balances that had aged past 90 days were finally collected.

Monthly collections before$166,700

Monthly collections at day 90$191,700

Increase per month$25,000

Annualized increase$300,000

Net return on the WeBill Health fee161%

Net return is the annualized increase in collections, minus the annual WeBill Health fee, divided by that fee. It is calculated before any savings from the practice’s previous billing arrangement.

The math

## Where the $25,000 a month came from

Estimated breakdown, built from orthopedic billing benchmarks and 2026 Medicare rates, tied to this practice’s measured before and after figures. Each line is a claim count multiplied by what those claims pay. A/R cleared from the old backlog is reported separately and is not part of this monthly gain.

| Change | Added a month |
|---|---|
| Denials stopped before they happenedAbout 834 claims a month at an average of $200 collected. Cutting the denial rate from 13% to 4.8% means 68 fewer denials a month. Before, about half of denials were never reworked, so 34 of those claims are now paid that were not. | $6,800 |
| Patient balances collectedPatients owe about $25,000 a month in copays, deductibles and coinsurance. Collection rose from 75% to 90%. | $3,750 |
| Separate visits paid on injection daysVisits with a separate evaluation billed with modifier 25 beside a 20610 or 20550 injection, 86 a month at about $108 each. | $9,288 |
| Underpaid claims recovered89 claims a month paid below the contracted rate, short by an average of $58, now appealed and recovered. | $5,162 |
| Added collections a month at day 90 | $25,000 |

Prior authorization moved to WeBill Health as well. The AMA 2025 survey puts that work at 13 hours a week per physician, or about 65 hours a week for 5 providers. At the national median wage for medical administrative staff ($45,930 a year, BLS May 2025) plus benefits, that workload is worth about $106,623 a year in staff time.

Codes and conditions

## The claims behind these numbers

| Visit type | Codes and rules | Typical conditions (ICD 10) |
|---|---|---|
| Visit plus joint injection | 99213 or 99214 with modifier 25 only for a separate evaluation, plus 20610 (0 day global) | Primary osteoarthritis, right knee M17.11 |
| Tendon sheath injection | 20550 (0 day global), laterality modifiers RT or LT | Trigger thumb, right thumb M65.311; impingement of right shoulder M75.41 |
| Viscosupplement series | J7325 with NDC, units and JW or JZ, prior authorization on most commercial plans | Primary osteoarthritis, right knee M17.11 |
| Imaging and follow up inside a surgical global | 73562 knee X ray; modifier 24 for unrelated visits, 79 for unplanned returns, 57 for the decision for surgery | Pain in right knee M25.561; low back pain M54.50 |

What it costs

## The 5% fee against the cost of doing this in house

This practice’s WeBill Health rate is 5% of collections. At $191,700 a month that is $115,020 a year. Here is what the same work costs a 5 provider practice that staffs it in house, before software and clearinghouse fees.

| Item | Per year |
|---|---|
| In house billing staff2 billers for 5 providers (MGMA: about one per two to three providers) at $73,160 each, the BLS median of $51,140 plus benefits | $146,320 |
| Prior authorization staff time13 hours a week per physician (AMA 2025), 65 hours a week, at the BLS median for medical administrative staff plus benefits | $106,623 |
| In house cost | $252,943 |
| WeBill Health fee, 5% of collections | $115,020 |
| Saved against in house staffing | $137,923 |
| Added collections a year | $300,000 |
| Better off each year with WeBill Health | $437,923 |

What other orthopedic practices can take from this

## Three orthopedic billing gaps worth checking this week

### Know what the global period already pays for

Major surgery carries a 90 day global period. Routine follow up visits inside it are included, while an unrelated problem needs modifier 24 and the decision for surgery needs modifier 57.

### Apply modifiers only when the note supports them

Procedure pairs flagged by NCCI edits are paid separately only when documentation shows distinct services. Modifier 59 or an X modifier without that support invites an audit.

### Authorize before the MRI and the surgery

Most payers require prior authorization for advanced imaging and elective surgery. The claim fails even when the care was necessary.

[Request a Revenue Defense Audit](https://webillhealth.com/audit)[See all specialties](https://webillhealth.com/specialties/)

Your practice next

## Find out what your orthopedic practice is leaving uncollected

The Revenue Defense Audit reviews your denials, aging A/R and patient collections the same way we did here. You get a written report that ranks the fixes by dollars at stake. We reply within one business day.

[Request a Revenue Defense Audit](https://webillhealth.com/audit)[Check my Revenue Defense Score](https://webillhealth.com/revenue-defense-score/)

Questions

## About this case study

How fast did the results appear?

Every figure on this page was measured at day 90, comparing the practice's baseline month with its third month on WeBill Health.

Why is the practice not named?

We protect our clients' privacy. The figures come from the practice's own billing reports.

What drove the biggest change?

The denial rate. Cutting denials from 13% to 4.8% meant far more claims were paid the first time, which lifted monthly collections and stopped new balances from piling up in aging A/R.

Does WeBill Health work with other orthopedic practices?

Yes. Orthopedics sits in our Procedure and Surgical billing group. Every account is handled by coding experts who work orthopedic claims every day.

WeBill Health is a specialty focused revenue cycle management partner for independent practices. Request a Revenue Defense Audit at https://webillhealth.com/form/