Orthopedic Claims Audit
Improve orthopedic revenue integrity.
Reimbursement is one of the toughest challenges in healthcare for orthopedic practices and musculoskeletal service lines. Surgical bundles, implant costs, global periods, modifiers, therapy services, and payer specific policies provide a great deal of opportunity for leakage and compliance risks.
Our Orthopedic Claims Audit Solution enables physician groups, orthopedic surgery centers, hospitals, and multi-specialty organizations to optimize claims accuracy and enhance compliance and minimize denials throughout the orthopedic revenue cycle.
Improve Orthopedic Revenue Integrity
Our audits are built for the changing healthcare reimbursement landscape in the U.S. in 2026, using a blend of orthopedic coding, payer intelligence and advanced analytics to uncover previously unidentified revenue opportunities and minimise financial risk.
What We Cover
Modifier 25 and Modifier 59 Analysis
Injection Procedure Audit
An examination of musculoskeletal injections including:
- Joint injections
- Trigger point injections
- PRP injections
- Ultrasound-guided procedures
- Pain management injections
Modifier 25 and Modifier 59 Analysis
In-depth analysis of modifier use, such as:
- Modifier 25
- Modifier 24
- Modifier 57
- Modifier 58
- Modifier 59
- Modifiers: XE, XP, XS, XU
What We Cover
There are a number of other
In our orthopedic audits, we routinely discover substantial opportunities for the recovery of revenue such as:
Under-Coded Procedures
- For procedures that are coded below the level of service documented.
There are a number of other
There are a number of other revenue leakage areas to consider, such as the following:
- Missed implant reimbursements
- Inaccurate package bills internationally.
- Bundled services billed incorrectly
- Imaging guidance services that are under reported
- Missed supply charges
- Therapy billing inaccuracies
- Payer underpayments
- Contract reimbursement discrepancies
Ready to strengthen your revenue cycle?
Let our specialty billing team handle the codes, claims, and follow-ups — so your clinicians can focus on patients.
The Orthopedic Claims Audit Focus Areas for 2026 are:
Our audits take a comprehensive look at the current orthopedic reimbursement trends and cover the following:
- Site-of-service reimbursement optimization
- The requirements for value based care reporting.
- AI-based Payer Claim Edits.AI Payer Claim Edits.
- Supercharging the review of prior authorizations
- The results of implant cost containment efforts.
- New Medicare outpatient payment rates.Outpatient rate changes for Medicare.
- Ambulatory Surgery Center reimbursement is changing.
- MSDPPs are bundles of payments for a group of musculoskeletal services.
- Risk-adjusted reimbursement methodologies
- Commercial payers update orthopedic policies.Orthopedic policy changes for commercial payers.
What We Cover
Typical Client Outcomes
Increased net collections
Typical Client Outcomes
- Increased reimbursement accuracy
- Reduced coding-related denials
- Improved modifier utilization
- Enhanced documentation compliance
- The revenue loss due to failure to recover missed revenue opportunities.
- Improve the quality of contract payments by payers.Improve contract performance by payers.
Frequently Asked Questions
Our services support: Orthopedic physician groups Orthopedic surgery centers Healthcare providers, hospitals, health systems. Sports medicine practices Spine surgery practices Multi-specialty physician organizations Ambulatory surgery centers
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Talk to ZechionMed about orthopedic claims audit.