Who We Serve/Orthopedics

Find where orthopedic revenue is leaking.Know what to do next.

Orthopedic practices lose revenue through preventable denials, underpayments, and cancellation-driven surgical or procedural capacity loss. The challenge is knowing where the issue is concentrated, why it appears to be happening, and which revenue integrity actions should be considered first.

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Orthopedic revenue leakage is rarely in one place.

Orthopedic practices often manage a mix of clinic visits, procedures, surgical cases, payer requirements, site-of-service decisions, and scheduling complexity. Revenue leakage can appear before the visit, during authorization, after billing, or when high-value capacity goes unused.

The issue is not just whether denials, underpayments, or cancellations exist. Leadership needs to see where those issues are concentrated, whether they appear recurring, and which areas deserve attention first.

The goal is a clearer revenue integrity view across claims, payments, scheduling activity, and operational context, without asking the team to manage another software system.

Authorization and payer rules

Elective procedures, site-of-service requirements, and documentation rules can create denial risk before reimbursement is ever received.

Procedure and payment variance

Orthopedic payment patterns can vary materially by payer, CPT code, provider, location, procedure type, and site of service.

Surgical and procedural capacity

Cancellations, unused slots, late schedule movement, and refill gaps can affect high-value capacity that leadership needs to understand clearly.

Why this matters for orthopedics

Orthopedic revenue leakage can sit across authorization, scheduling, claims, payer behavior, payments, and procedural capacity. Leadership needs those signals connected clearly enough to know what deserves attention first.

What orthopedic practices need to see clearly.

The goal is not more reporting. The goal is a clearer answer across denials, underpayments, cancellations, and the operating patterns that affect revenue integrity.

Preventable denial leakage

Denial Prevention

Orthopedic practices often face denial patterns tied to authorization, medical necessity, documentation, coding, payer requirements, and site-of-service rules. The value is knowing which denial patterns are recurring, preventable, and worth addressing first.

Authorization and medical necessity risk

Denial Prevention

Elective orthopedic procedures can be exposed to authorization delays, payer rules, medical necessity requirements, and documentation gaps. Leadership needs visibility into where these issues may be creating denial risk, cancellation risk, or both.

Underpayment exposure

Revenue Integrity

A paid orthopedic claim does not always mean the payment was right. Practices need visibility into where earned revenue may not have been fully collected across payers, CPT codes, providers, procedures, and locations.

Procedure and payer reimbursement variance

Revenue Integrity

Orthopedic reimbursement can vary by payer, procedure, provider, location, implant-related complexity, and site of service. The goal is to surface where payment patterns deserve deeper finance or revenue cycle review.

Cancellation-driven revenue loss

Cancellation Impact

Cancellation rates are easy to report. The harder question is where cancellations are concentrated, which procedural capacity is being affected, and which scheduling issues may be creating revenue integrity risk.

Surgical and procedural capacity visibility

Practice Visibility

Orthopedic practices need to understand where schedule instability, unused capacity, late cancellations, or refill gaps may be affecting surgical and procedural volume across providers and locations.

The questions leadership should be able to answer.

Orthopedic practices usually have the data. The gap is turning the data into clear answers leadership can act on.

Denials

Which denial categories are recurring and preventable?
Which payers, providers, locations, procedures, or workflows appear to be driving denial leakage?
Which denial issues should leadership address first?

Underpayments

Where did the practice earn revenue but collect less than expected?
Which payers, CPT codes, procedures, providers, or locations show reimbursement variance?
Which payment gaps deserve finance or revenue cycle review?

Cancellations

Where are cancellations creating unused surgical or procedural capacity?
Which appointment types, providers, locations, procedures, or payer groups are most exposed?
Which scheduling issues may be affecting revenue integrity?

The work starts with the data already available.

Orthopedic practices should not need to adopt another software system just to understand where revenue integrity is breaking down. The starting point is the data already produced by the practice.

Prexisio uses the practice’s claims, payment, scheduling, and supporting operational files to identify where leakage appears concentrated and what leadership should examine first.

Scheduling Data

Appointment activity, surgical schedules, cancellations, reschedules, provider schedules, location activity, and procedural capacity

Claims Data

Submitted claims, CPT codes, payer activity, service locations, providers, denial patterns, and procedure mix

Payment Data

Allowed amounts, paid amounts, remittance activity, payer variance, and reimbursement patterns

Operational Files

Supporting context such as authorization status, site-of-service mapping, procedure type, location mapping, and internal workflow files when available

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