- +1 (773) 985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Stream RCM delivers inclusive healthcare revenue cycle management in medical billing for practices, physicians, and healthcare organizations to manage the full RCM lifecycle from patient intake and claim submission to denials resolution and final reimbursement. Minimize denials, boost cash flow, and strengthen financial performance.
Where revenue loss
They fail where orthopedic-specific expertise is missing.
What you get from Stream RCM
A denial trend associated with total knee arthroplasty is different from a carpal tunnel release.
Our team performs complicated coding for total hip replacement (27130) and knee arthroplasty (27447), which include implant billing and global period. We make sure that all the modifiers are applied correctly.
We handle accurate coding for fusions (22612) and decompressions, handling multiple levels and comorbidities. We navigate payer-specific pre-authorization and bundling guidelines to avoid denials.
Our coders cover all services from ACL repairs (29888) to arthroscopic shoulder procedures (29827) to make sure there is complete coverage of all sports-related injuries.
The use of such modifiers as -25 and -59 helps us in mastering coding of fractures. Documentation reviews protect us from denials caused by the abuse of global packages.
We expertly code growth plate fractures, scoliosis, and congenital problems, using the appropriate ICD-10 codes for the patient’s age. We make sure conformity to the payer’s pediatric policy.
From carpal tunnel release to tendon repair, we correctly differentiate staged procedures so that all billable services can be coded instead of being lumped quietly into one code.
We provide Revenue Cycle Management (RCM) services designed specifically for orthopedic practices. Our team manages the entire financial lifecycle of your patient visits so you focus on delivering exceptional musculoskeletal care.
We look for trends in denial rates, address underlying problems, and contest denied claims. This results in 40% increase in recovered revenue through disputing payer errors.
The A/R department actively pursues aged claims using predictive analytics to target valuable accounts. We decrease aged AR greater than 120 days by 25% in 90 days.
We provide pre- and post-submission audits to ensure that we capture all possible coding errors, overlooked chargings, and compliance issues that could be associated with your practice.
Our AAPC-certified coders have specialization in Orthopedic CPT codes, ICD-10, and HCPCS Coding. Our team makes sure proper use of modifiers for multiple or bilateral procedures.
Our staff is responsible for enrolling, revalidating, and credentialing both surgeons and PAs to ensure that they are in network and prevent any revenue leakage due to out-of-network denials.
We provide meticulous payment and denial reconciliation, line-item posting into your PM system. We identify any underpayments and seek payer correction.
Uncover lost revenue. Schedule your free orthopedic billing consultation today.
The combination of high denials, fewer staffing resources, and frequent payer policy changes has pushed many orthopedic practices to move away from internal bill management. The staff in these offices frequently have to deal with appointments, prior authorizations, and codes all at the same time, making it difficult for them to stay on top of changes in modifier rules and appeal deadlines. An orthopedic billing company like Stream RCM is likely to help such practices to get their cash flow steady much quicker than other methods because of the filing of claims by those who are working strictly in musculoskeletal codes. This way, they also relieve themselves from the expense of training new coders, one of the most common reasons for revenue drops in orthopedic offices.
| Procedure | CPT / ICD-10 | Coding Note |
|---|---|---|
| Knee Arthroplasty | 27447 / M17.11 | We make sure laterality and existing hardware history prior to submission, thus avoiding denials due to bundling issues that often arise in unilateral knee replacements. |
| Shoulder Repair | 29827 / M75.100 | Rotator cuff arthroscopy is cross-verified by our team through imaging reports for proper matching between the coding method and the procedure being done. |
| Hip Replacement | 27130 / M16.11 | Our team guarantees consistency between approach and implant from the operative report, thereby avoiding any discrepancy that results in payer manual review. |
| Spine Fusion | 22551 / M50.20 | Cervical disc displacement descriptions are matched to the numbers of fusion levels so that multiple-level surgery is not undercoded with one description. |
| Knee Arthroscopy | 29881 / M23.221 | The meniscal derangement descriptions are looked at to confirm that there is compartment information and that the arthroscopy procedure code matches what was done. |
Grafting is another element that general orthopedics coding fails to capture. Whether the surgeon uses autograft, which is taken from the patient himself, allograft, which is donated tissue, or synthetics, the coding process differs based on the source of the graft, material used, and if the procedure was a separate billing or incidental to some other surgical procedure. Medical necessity documentation is required for procedures such as spinal fusion, repair of a nonunion fracture, and revision joint surgery when there is grafting involved. Stream RCM will review each surgical note for these cases line by line to ensure that the correct type of graft, method of harvest, and application site is determined before billing for the case.
Our orthopedic billing solutions will perfectly work together with your current EHR or EMR system. There will be no need for you to make any modifications or provide direct access to your system.
The use of platelet rich plasma therapy and other Ortho biologics is increasingly becoming part of the usual orthopedic treatments, but there is lack of consistent payment coverage in these kinds of medical services. Most commercial insurance companies still consider Ortho biologic injections to be investigative treatment, which means that they will not pay regardless of the quality of clinical documentation. Billing services in medical orthopedic have to determine whether a procedure is payable or not before filing any claims, protecting their income and avoiding confusion with the patient’s billing statement. Otherwise, the practice will be prone to balance billing and payment delay. Stream RCM evaluates Ortho biologic payments case by case, so patients and providers know financial responsibility before treatment begins.
Orthopedic claims fail in patterns but Stream RCM targets the root causes of denials to protect your revenue. From modifier misuse to global period violations, we provide proactive solutions that eliminate recurring issues and boost clean claim rates.
Our team provides cost-effective orthopedic specialty billings that increase the financial performance of your practice.
The billing specialists at Stream RCM will prevent any coding mistakes and speed up the process of insurance payments.
The right orthopedic medical coding combined with denials management helps you get compensated to the fullest extent possible.
When you outsource revenue cycle management, your medical staff will no longer have to deal with the paperwork and will be able to concentrate only on the patient results.
We keep up with the changes in CMS rules and private insurance company regulations by providing detailed documentation to avoid any audits and penalties.
We track each surgery date and global window per payer, identifying follow-up visits so staff know which encounters are billable and which fall inside the period.
Yes. Provider credentialing, payer paneling, and re-validation tracking are included, so enrollment issues never quietly interrupt reimbursement for a surgeon already seeing patients.
We review operative documentation, confirm graft or device detail, and file appeals with supporting records, since these claims usually fail on documentation gaps rather than eligibility issues.
Orthopedic claims involve global periods, staged procedures, and implant tracking that general coders rarely handle daily, which is why our coders work within musculoskeletal specialties.
Most practices notice measurable denial reduction within the first two to three billing cycles, once documentation gaps are identified and corrected at the source.
Let’s review your current billing process together, free of charge.
