Orthopedic A/R recovery
Orthopedic A/R ages for reasons specific to surgical practice: prior authorizations that do not match the procedure performed, global-period and modifier denials, implants and durable medical equipment billed without the required documentation, workers' compensation and auto-liability claims that follow their own rules, and multiple-procedure reductions applied incorrectly. MARR Partners works these 90+ day claims for orthopedic groups on a contingency fee, alongside the existing billing team.
Why orthopedic A/R ages
Orthopedic revenue is concentrated in high-dollar surgical claims with many moving parts: an authorization obtained for one CPT code while a different or additional procedure is performed, an assistant surgeon or co-surgeon line billed without the right modifier, an implant invoice the payer never received, or a follow-up visit billed inside the global period without modifier 24 or 79. Each is a correctable denial, but each takes a records pull and an appeal letter, which is exactly the work a busy surgical billing team defers. Workers' compensation and auto-liability claims add state-specific fee schedules, bill-review vendors, and dispute processes that generalist billers rarely track.
Common orthopedic denials and the recovery path for each
| Denial | Typical cause | Recovery path |
|---|---|---|
| Prior authorization mismatch | Authorization covers a different CPT, level, or laterality than what was performed; add-on procedures not authorized | Retro-authorization where the plan allows; appeal with operative report showing the intra-operative finding |
| Global surgical period | E/M or procedure billed inside the 10- or 90-day global without modifier 24, 25, 57, 58, 78, or 79 | Corrected claim with the correct modifier and documentation of the unrelated or staged service |
| Assistant / co-surgeon | Modifier 80, 81, 82, AS, or 62 missing or not payable for the CPT per payer policy | Corrected claim; appeal with operative note where the assistant was medically necessary |
| Implants and supplies | Invoice or implant log not attached; billed under the wrong revenue code or HCPCS | Resubmit with invoice and log; dispute against the carve-out in the contract |
| DME and bracing | Missing detailed written order, medical-necessity documentation, or proof of delivery | Supply the order and delivery record; appeal |
| Multiple-procedure reduction | Payer applied a 50% or greater reduction to procedures exempt from it, or ranked procedures incorrectly | Underpayment dispute citing the fee schedule and NCCI/MPPR rules |
| Workers' comp / auto liability | Claim sent to the wrong carrier, missing claim number or adjuster, or reduced by a bill-review vendor | Refile to the correct carrier with the claim number; state fee-schedule dispute |
What we look for in your aging report
- Surgical claims over $2,500 with a prior-authorization denial and an operative report on file
- E/M visits denied inside a global period (the largest count of small, fast fixes)
- Implant lines paid at zero or bundled
- Claims with modifier 80/82/AS/62 paid at zero
- Workers' compensation and liability claims with no adjuster contact recorded
- Procedures paid at the multiple-procedure rate that are exempt from it
Who it is for
Independent orthopedic groups and orthopedic surgery practices with 5–40 surgeons, including spine, sports medicine, joint replacement, hand, and foot and ankle. Practices with an ambulatory surgery center see the same problems on the facility side.
Fee: 12–18% of recovered revenue by claim age, invoiced after the payer pays the practice. No setup fee, no minimum, no long-term contract. Start with the MARR 90+ Day Recovery Audit.
How it works
Send aging report
Your 90+ day aging report through a secure link under a BAA.
MARR analyzes recoverability
Every claim is checked against deadlines, payer rules, and the denial reason.
We work approved claims
Corrections, documentation, appeals, and disputes, claim by claim.
You pay on recovered revenue
Payers remit to you. Our fee is invoiced on remittances actually received.
Related articles
Sources
- CMS, Medicare Physician Fee Schedule (global surgery periods, multiple-procedure rules, modifiers)
- CMS, National Correct Coding Initiative (NCCI) edits and policy manual
- CMS, Medicare timely filing requirements
- CMS, Original Medicare appeals process and deadlines
- American Medical Association, prior authorization physician survey and resources
Figures attributed to a source are that source's; commonly used benchmarks are labeled as such. Verify deadlines against your own payer contracts.