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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.
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.
Authorize and verify first
- Prior authorization secured for surgery and advanced imaging
- Eligibility verified and patient balances collected before the procedure
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
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 betterClean claim rate
Higher is betterA/R over 90 days
Lower is betterPatient balances collected
Higher is betterMonthly collections
Higher is betterEvery 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.
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.
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.
Your practice next
Find out what your orthopedic practice is leaving uncollected
The Revenue Health 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.
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.