To switch orthopedic billing companies without losing revenue, plan the handoff around the claims that span both vendors: surgeries still inside a 90-day global period, open workers’ comp claims, authorizations for scheduled cases and surgery center facility claims. Set clear cutoff dates, get a full data export, and run both teams in parallel for at least one payment cycle.
Why is switching harder for an orthopedic practice?
Every practice that changes billing companies has to move old AR, credentialing and system access. Our general guide on how to switch medical billing companies without a cash flow gap covers those steps.
Orthopedic practices have more to plan for. A total knee done in the last week with the old vendor still has three months of post-op care ahead of it. A workers’ comp patient may have an open claim with an adjuster who only knows your old billing contact. Surgeries booked for next month may already have authorizations tied to the old submitter. If your group owns a surgery center, the facility claims move too.
None of this should stop you from switching. It just means an orthopedic transition needs an ortho-specific plan.
How do you handle surgeries inside a global period?
Most major orthopedic procedures carry a 90-day global period. The surgeon’s fee covers routine post-op visits during that time, and those visits are only billed separately in specific cases, such as an unrelated problem or a return to the operating room. CMS lays out the rules in its Global Surgery Booklet.
During a switch, this creates a simple risk. The new team may not know which patients are still in a global period, so they bill visits that should be bundled or miss the modifiers on visits that can be billed. To prevent this:
- Ask the old vendor for a list of every surgery in the last 90 days, with the procedure, date and surgeon.
- Load that list into the new team’s system before the first post-op visit is billed.
- Review the first few weeks of post-op claims by hand to confirm modifiers are right.
What happens to open workers’ comp and auto claims?
Workers’ comp and auto claims move slowly, and they depend on relationships with adjusters and case managers. They are also the claims most likely to be forgotten in a switch, because the outgoing company has little reason to keep chasing them once the contract ends.
Before cutover, get a separate list of every open comp and auto claim, with the claim number, adjuster name and contact information, date of injury, and the last action taken. Decide in writing who works each claim to the finish. Then send each adjuster a short notice with the new billing contact, so payments and requests for records don’t go to a company that no longer handles your account.
If comp is a large part of your payer mix, ask any new vendor how they track comp claims on their own. Our post on orthopedic workers’ comp billing explains why those claims stall and what speeds them up.
Scheduled surgeries are where a billing switch can hurt the most, since one denied joint replacement can cost more than a month of office visits. Pull a list of every case on the schedule for the next 60 days and confirm three things for each one:
- The authorization is approved and matches the procedure codes that will be billed.
- The authorization is still valid on the new surgery date if the case was moved.
- The new team knows where the authorization is stored and who to call if it changes.
Implant-heavy cases need one more check. Many commercial contracts pay implants separately and require the invoice with the claim. Make sure the new team knows which contracts do this and where the invoices come from.
What changes if your group owns a surgery center?
If your group owns an ASC, the facility claims have their own fee schedules, payer contracts and edits. Decide early whether the new vendor will bill both the professional and facility side, and set cutoff dates for each. Confirm the facility’s payer enrollment and fee schedules are loaded before the first case is billed. Our ambulatory surgery center billing page explains how the facility side works.
How do you keep old AR from slipping past filing limits?
Old claims lose value fast once nobody owns them. Medicare generally allows 12 months from the date of service to file a claim, as set out in the Medicare Claims Processing Manual. Commercial payers and workers’ comp carriers often allow much less, and every contract is different.
Set a last date of service for the old vendor and a first date of service for the new one, so every claim has an owner. Get a full export of open claims, denials and patient balances before the contract ends. Then track the old AR on its own report until it is paid, appealed or written off. If you don’t know what is sitting in your AR today, start with our post on AR that keeps climbing with no answers from your billing vendor.
What should an orthopedic transition timeline look like?
Every practice is different, but most orthopedic transitions follow the same order:
- Before you sign: get a review of your current AR, denials and payer mix, and agree on who works the old AR.
- First few weeks: confirm credentialing and enrollment, set up clearinghouse and EHR access, and pull the global period, comp and surgery schedule lists.
- Cutover: the new team starts billing new dates of service. Send test claims first and check the results.
- Parallel run: watch clean claim rate, denials and payments for at least one full payment cycle from each major payer.
- Close out: retire the old vendor once old AR is worked down and the new numbers hold.
Enrollment changes can take weeks, so give yourself more time than you think you need.
What should you ask a new orthopedic billing company about the switch?
The sales process is the best time to find out how a company handles transitions. Ask:
- Who will work our old AR, and is that included in the price?
- How do you handle patients who are mid-global period at cutover?
- How do you track workers’ comp and auto claims separately?
- Can you show us a sample report with AR split by payer type?
- Can we speak with an orthopedic practice that switched to you in the last two years?
Medical Healthcare Solutions, Inc. (MHS), based in Andover, Massachusetts, has worked in healthcare revenue cycle management for more than 30 years, and MHS clients stay an average of 14.5 years. You can see how we approach orthopedic claims on our orthopedic medical billing services page.
Frequently asked questions
Will we lose revenue when we switch orthopedic billing companies?
Not if the switch is planned. Set cutoff dates, get a full export of open claims, track global periods, comp claims and scheduled surgeries, and run both teams in parallel for at least one payment cycle.
Who bills post-op visits for surgeries done before the switch?
The new team does, for visits after the cutover date. They need a list of every surgery in the last 90 days so they know which visits fall inside a global period.
What happens to open workers’ comp claims when we change billers?
Get a list of every open comp claim with the claim number and adjuster, decide in writing who works each one, and send adjusters the new billing contact.
How long does it take to switch orthopedic billing companies?
It depends on your size, payer mix and whether you own a surgery center. Enrollment changes can take weeks, and a parallel run should cover at least one full payment cycle.
Thinking about a change but worried about the handoff? Get Pricing & Analysis and MHS will look at your AR, open comp claims and payer mix, then map out what a switch would involve for your practice.
