Trusted Orthopedic Billing Services That Boost Revenue

PGM: Established Leaders in Orthopedic Medical Billing

Operating a successful orthopedic practice demands specialized billing support that increases revenue while streamlining operations. At PGM, we provide expert orthopedic billing services, helping practices navigate complex insurance processes and secure the maximum reimbursement they deserve.

As one of the nation’s top orthopedic billing companies, earned through our long history of delivering results, PGM brings in-depth knowledge of coding, payer protocols, and compliance specific to orthopedic care. Our experienced team handles everything from claim submission to denial management, ensuring your revenue cycle is optimized and efficient, so you can spend more time delivering great patient outcomes and spend less time worrying about your bottom line.

Whether your focus is on joint care, sports injuries, surgical procedures, or any other aspect of orthopedics, our customized orthopedic medical billing services are built to support your practice’s financial health. Orthopedic providers continue to choose PGM for our precision, transparency, and proven results.

Reach out to us today and learn how our specialized billing for orthopedics will help your practice thrive.

The Preferred Partner for Orthopedic Billing Services

A thriving orthopedic practice requires more than clinical excellence — it demands expert handling of their complex billing services. From precise coding to payer-specific requirements, the financial health of your practice hinges on efficient and compliant coding and billing operations. At PGM, we specialize in managing the full orthopedic revenue cycle, helping our provider partners secure the reimbursement they have earned and deserve while easing practice workload. Our team is well-versed in the challenges unique to orthopedic medical billing, including surgical coding, authorization management, and the ever-evolving compliance regulations.

With decades of experience, PGM stands out as a leader among orthopedic billing companies, delivering personalized, scalable solutions that support growth and improve revenue performance. We combine expert staff, leading-edge technology, and a proactive approach to claims management to boost clean claim rates, minimize denials, reduce accounts receivable, and strengthen cash flow. Whether you’re an independent orthopedic specialist, part of a group practice, or managing a large orthopedic facility, you can count on our end-to-end orthopedic billing solutions.

The Complex, Ever-Changing Landscape of Orthopedic Medical Billing

Billing for orthopedic services presents a distinct set of challenges – from payer variability to strict documentation and compliance standards that undergo frequent changes. Successful orthopedic medical billing services require deep expertise to navigate reimbursement rules and avoid costly delays or denials.

Every payer has its own criteria for treatments and procedures like joint replacements, physical therapy, and postoperative care. From modifier use to bundled payment models, even the smallest of errors can trigger claim rejections or revenue shortfalls. For example, some insurers require prior authorization for advanced procedures, while others demand detailed operative reports and time-based documentation for therapy.

Working with Medicare and Medicaid adds yet another layer of complexity to orthopedic coding and billing. These programs impose stringent billing protocols for orthopedic services, where even seemingly minor deviations can lead to audits, repayment demands, penalties, and clawbacks. That’s why more providers are looking to outsource their revenue cycle management and turn to professional orthopedic billing companies like PGM. With the right partner, orthopedic practices can feel more confident that their billing is being managed by a team whose sole focus is the revenue cycle and protecting clients’ revenue.

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Comprehensive Orthopedic Billing Services by PGM

PGM delivers expert orthopedic billing services designed to ensure compliance, maximize reimbursements, and reduce claim denials. With deep knowledge of orthopedic billing requirements, we help practices improve their revenue cycle performance and while achieving operational efficiencies – as we have been doing so for decades.

Orthopedic Procedure Billing

Orthopedic medical billing requires precision in coding and documentation. Whether it’s fracture management, joint injections, or surgical procedures, PGM ensures accurate coding and timely claim submission to avoid underpayments, rejections, and compliance issues – and to better ensure timely and appropriate payments.

Expert Modifier Usage

Correct use of CPT and HCPCS modifiers is essential when billing for orthopedic procedures involving multiple services, bilateral operations, or staged surgeries – just to name a few examples. PGM’s expert team works to always ensure consistent, accurate modifier application, improving reimbursement outcomes while staying within payer guidelines.

ICD-10 Coding Accuracy for Orthopedics

Accurate ICD-10 coding is key to properly documenting conditions like osteoarthritis (M19.90) or rotator cuff injuries (M75.121). Our certified coders stay up to date with the latest code changes, increasing claim accuracy and reducing the risk of denials.

What You Can Expect With PGM: Optimized Revenue and Compliance

PGM’s specialized orthopedic medical billing services are built to enhance revenue. On average, our clients see a 20–30% increase in collections, a 40% reduction in denials, and significant gains in revenue cycle efficiency. All of these translate into healthier bottom lines.

How PGM Delivers Superior Results in Orthopedic Billing

PGM leads the way in orthopedic billing services by combining our advanced technology with expert support to increase revenue and reduce administrative pressure. Our experienced team understands the detailed requirements of billing for orthopedic procedures, helping providers achieve full reimbursement without delays or denials that can hamper growth. With a proactive approach to revenue cycle management and the latest tools and solutions, we help our practice clients operate more efficiently while meeting evolving regulations.

Our proven success in orthopedic medical billing is driven by key strengths. These include the following:

Complete Orthopedic Billing Services
From claim entry through the entire revenue cycle, we deliver precision, speed, and reliability.
Integrated Orthopedic Billing Software
Our technology platform automates key tasks, enhances coding accuracy, and reduces manual errors.
Reimbursement Strategy & Payer Collaboration
We work directly with insurers to secure the best possible rates and collections for orthopedic billing.
Customized Billing Solutions
very orthopedic practice is different. Our services are tailored to our client’s specific needs and workflow.
Regulatory Expertise
We stay on top of Medicare, Medicaid, and commercial insurance updates to ensure our team is always following the latest rules.
Denial Management & Revenue Growth
We proactively track and resolve claim issues fast, increasing collections and improving financial health.
Full-Service Orthopedic Revenue Cycle Management
Our team manages all facets of orthopedic RCM, from patient eligibility to posting payments and generating reports.
Data-Driven Performance Insights
Our advanced analytics tools provide actionable financial data, allowing your team to collaborate even more closely with ours to make more informed decisions and improve billing outcomes.

PGM Revenue Cycle Management

Medical Coding

According to the AMA, the average medical practice submits more than 50% of its claims with incorrect codes. Inexact and inconsistent coding increases the risks of undercharging, overcharging and post-payment audit.

At PGM, all of our clients undergo a practice evaluation where our certified coders, in conjunction with our reimbursement specialists, analyze practice procedures and codes to make recommendations that ensure accurate and optimum reimbursement.

Patient Charge and Demographics Data Entry/Upload

Patient demographics and charges are collected from your office daily. Data can be scanned, faxed or couriered to any one of our locations. Once the data has been received, a dedicated PGM account representative will enter the information into our practice management system.

For PGM clients using an electronic medical record system (EMR/EHR), patient demographics and charge data can be electronically transferred in real-time to our practice management system though our EMR/EHR medical billing interface.

Claims Review

PGM's reimbursement specialists compile and review all client patient and charge data. Billing uploads and batches are balanced, and our medical claims process software is used to 'scrub' claims for errors and omissions. PGM's software performs thousands of checks, including CPT/ICD-9 validations, modifier checks, demographic comparisons and payer-specific edits.

The claims review process ensures that practice billing data is being accurately captured and that claims are clean prior to being submitted for payment. Clean claims greatly increase the rate of payment, helping to maximize the amount collected and reduce accounts receivable.

Claim Submission

Once the claims are reviewed and audited, they are transmitted to the various payers for reimbursement. PGM has the ability to electronically transmit claims to thousands of payers nationwide. For those payers that do not have the ability to receive electronic claims, PGM will generate and mail paper claims.

After submission, claims receive an additional level of "scrubbing' by our clearinghouse. Edits and errors are relayed back to PGM for correction.

Payment Posting

Payments are received either hard copy or via electronic remittance advices (ERA). PGM clients are given the option to continue to receive payment at the practice or to have PGM manage all payments at one of our facilities.

Once payment is received, it is reviewed and line-item posted into our practice management system by one of our reimbursement specialists.

Claim Tracking

Once payments have been posted into our practice management system, they are run through our payer-specific rules software, which aggressively detects unpaid or misadjudicated claims.

Once an unpaid or misadjudicated claim is flagged, it is brought to the attention of one of our reimbursement specialists for further investigation and active follow-up.

Denial Management and Follow-up

Only 70% of the average medical practices insurance claims are ever paid by insurance providers. While a practice may submit a perfectly clean claim to a payer, there is no guarantee that it will get paid or, for that matter, get paid accurately.

It's no secret that payers continue to impose increasingly complex rules, systems and loopholes with the single goal of limiting payment. This frequently means that practices remain unpaid on the valuable service provided to patients.

PGM's incentive-based fee structure ensures that we work hard to make sure nothing gets left behind. Once an outstanding claim has been identified as past due, PGM's system alerts our account representative who then reviews the history and follows up on the claim accordingly.

Patient Balances Billing

At PGM, we understand that patients are the lifeblood of the practice. We work directly with the practice to custom tailor a patient billing profile to perform all patient billing functions on behalf of the practice.

The typical patient billing profile includes a series of easy to understand statements. Should a patient fail to make payment, additional letters and/or a call sequence is initiated. For questions regarding a bill, patients are provided a toll-free number to call where one of our patient billing specialists is ready to answer any questions.

PGM does not perform collection services, and therefore patient billing services are structured to encourage patients to resolve outstanding balances. For those patients who refuse or are unable to complete their obligation, PGM will work with the practice to structure a patient payment plan or transition the balance to a third-party collection agency for resolution.

Reporting

PGM provides advanced financial and practice analysis tools designed to give enhanced visibility into practice operations at the click of a button. Practices are provided access to PGM-online, our Internet-based reporting system, where they can access hundreds of practice analysis and performance reports. Should a practice require additional information, custom reports are also available upon request.

Additionally, PGM's reimbursement specialists provide frequent practice performance reviews offering additional insight into practice financial operations.

Smart, Sophisticated Software for Orthopedic Billing

PGM’s cutting-edge software is designed to simplify orthopedic medical billing, reduce errors, and enhance billing performance. With seamless EHR integration, providers eliminate duplicate data entry and improve coding accuracy. Real-time claim tracking and built-in compliance tools help our clients stay current with insurance requirements and manage patient information with ease. Our robust reporting features also support stronger orthopedic revenue cycle performance through better visibility into trends, reimbursement outcomes, and opportunities for improvement.

With our unmatched expertise in orthopedic billing, PGM helps practices of all sizes achieve greater efficiency, stronger financial results, and fewer administrative challenges. Partner with PGM and let us handle the complexities of orthopedic billing services, so you can allocate more time and resources to delivering patient care and supporting more of your community.

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Why PGM Is the Right Partner for Your Orthopedic Billing Needs

PGM delivers specialized orthopedic billing services designed to streamline the revenue cycle, drive down denials, and ensure accurate, timely reimbursement that powers growth and profitability. Our experienced billing team understands the intricacies of orthopedic medical billing, from procedure-specific coding to payer compliance. We provide comprehensive, right-sized solutions to strengthen cash flow and support short- and long-term financial health. With our innovative technology and proactive service, PGM empowers orthopedic providers to reduce administrative overhead and concentrate on patient care. Trusted by practices nationwide, we’ve long been recognized as one of the best orthopedic billing companies in the industry.

In-Depth Expertise in Orthopedic Billing Services

With decades of experience in billing for orthopedic practices, PGM helps providers maximize collections while staying in line with insurance requirements. Our team handles all aspects of the orthopedic revenue cycle, including coding for complex procedures, securing prior authorizations, and adapting to ever-changing payer guidelines. From eligibility verification through payment reconciliation, we provide the end-to-end support that helps practices operate more efficiently and profitably.

Certified Professionals in Orthopedic Medical Billing

Our certified billing experts stay current with the latest CPT, ICD-10, and HCPCS codes to ensure coding and billing compliance and clean claims. We have deep experience billing for a wide range of orthopedic services. They include:

Arthroscopy procedures (CPT 29877, 29881)
Total joint replacements (CPT 27447, 27130)
Fracture care and casting (CPT 26605, 27788)
Pain management injections (CPT 20610)
Follow-up and global period coding compliance

Tailored Billing Solutions for Today’s Orthopedic Practices

Unlike general billing companies, PGM has deep expertise specifically in orthopedics billing. We provide personalized orthopedic medical billing services built to fit the specific workflows of our clients. Since our software integrates seamlessly with most EHR platforms, this allows for the likes of automated charge capture, accurate claim generation, and simplified processes. Features include the following:

Automated billing tools that reduce missed charges and improve accuracy
Real-time financial dashboards for transparent revenue tracking
Integrated eligibility checks to prevent claim rejections
Secure, HIPAA-compliant electronic claims processing for faster payments

With PGM’s advanced orthopedic billing systems, practices benefit from smoother operations and stronger bottom-line performance.

Optimized and Accurate Reimbursement

PGM focuses on maximizing revenue through detailed coding, efficient claim handling, and proactive denial management. Our services include:

Precise coding and documentation to support medical necessity
Fast, accurate submission of claims for orthopedic services
Appeals management to recover lost revenue from often incorrectly denied claims
Direct communication with payers to negotiate fair reimbursement rates and resolve bottlenecks

When you choose PGM for your orthopedic billing services, you gain a partner committed to improving revenue, accelerating cash flow, and reducing the stress of executing proper coding and billing.

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Dedicated Support for Orthopedic Billing Success

At PGM, we deliver expert orthopedic billing services backed by personalized support to help practices run more efficiently and grow their revenue. Established as one of the top orthopedic billing companies, we provide proactive guidance, hands-on assistance, close collaboration, and deep industry knowledge to navigate the complexities of billing for orthopedic procedures. From managing pre-authorizations to ensuring accurate documentation, our tailored approach optimizes cash flow.

Responsive, Personalized Client Support

PGM assigns each of our practice clients a dedicated account manager with expertise in orthopedic medical billing. Then, our team works closely with staff to improve efficiency, resolve issues quickly, and drive down the risk of denials. We’re more than a service provider — we’re an extension of each of our client’s team, invested in their financial success.

Specialized Knowledge in Orthopedic Revenue Cycle Management

Our billing professionals understand the detailed coding, documentation, and compliance requirements unique to orthopedic billing services. Whether it’s joint replacements, fracture care, or arthroscopic procedures, we work tirelessly to ensure every claim is correctly coded and always aligned with payer guidelines. This expertise translates into fewer denials, faster payments, and stronger revenue cycle performance year after year.

Efficient and Accurate Claims Processing

Our streamlined claims management system is central to our approach and results. We review and submit claims with precision, flag potential issues early, and manage follow-ups to avoid revenue leakage. This level of oversight increases clean claim rates and improves cash flow./p>

Proactive Compliance and Risk Management

Staying compliant with Medicare, Medicaid, and commercial payer requirements is essential in orthopedic medical billing. PGM closely monitors regulatory changes and applies the latest best practices to help your practice stay aligned and avoid costly penalties and delays. With our compliance-first mindset, you can rest easy knowing we are protecting your revenue and your reputation.

Improved Financial Outcomes for Your Practice

With PGM managing your orthopedic billing, your practice benefits from complete revenue cycle oversight, consistent support, and a clear path to financial stability. We help you reduce billing errors, increase reimbursement, and free up internal resources — so you can focus on patient care, not paperwork.

Discover the Difference in Orthopedic Billing with PGM

Looking to elevate your practice’s financial performance? Contact PGM today to schedule a free consultation and learn how our expert orthopedic billing services can deliver the results you need.