image if a group of orthopedic specialists

Pros & Cons of Outsourced Billing for Orthopedics

For orthopedics offices and orthopedic surgeries, aggressive revenue cycle management (RCM) is a big factor in financial success. With complex clinical needs and equally complex medical billing claims, it’s important to make sure revenue doesn’t slip through the cracks. 

A billing team that understands the nuances of orthopedics is absolutely essential. But should you build that team in-house to rely on external talent? 

Whether in-house or on an outsourced team, the right talent makes a difference.

Outsourced medical billing and RCM could be the best choice you make for your bottom line. But when it comes to orthopedics practices, it’s important to consider the pros and cons.

Cons of Outsourced Billing for Orthopedics

Orthopedics is a complex specialty, and clinical details make a big difference. Your medical billing team, in-house or outsourced, needs to know those details thoroughly. Make sure your team understands:

  • How to properly document and code complex open and arthroscopic procedures
  • The proper units and anatomical categories for foot procedures
  • Accurate spinal regions
  • How to code the different components of a hip or knee replacement
  • How to report implants

Because orthopedic coding requires such intricate content, knowledge of payer trends and payer policy is critical. 

Less Control

You’re no longer directly responsible for training and day-to-day supervision with outsourced orthopedic billing partners. You’re also not responsible for staff incentives and retention. Whether that is negative depends on your practice’s strengths and on how much you trust your outsourced billing partner. In some cases, delegating some of that responsibility to an experienced outside team can be a positive experience — just make sure you find a billing partner whose standards and values mirror your own.

Less Visibility

Many billing providers give only high-level insights into the status of your account. If monthly reports are only surface level, it can be harder to identify bad habits or consistent errors that could cost your practice over time. Gentem is an exception: we offer your practice a live medical billing dashboard with summary data and individual claim level detail. 

This allows you to see everything from how much your clinic has earned over any period to how an individual claim was coded and everything in between. 

With all your data at your fingertips, your in-house billing manager can stay in control of the financial details. Our partners have the same visibility they would have if the RCM team were in their office, which minimizes risk.

Risk Potential

That brings us to the most significant potential negative to outsourced orthopedic billing: risk. The quality of outsourced billing providers varies dramatically. When outsourcing, it’s essential to do your due diligence and find a provider that will push for every dollar your practice deserves.

When considering an outsourced company, you must ask this question: How can we hold you accountable? You should get a clear answer and a genuine concern for your business.

The flip side of risk, of course, is the reward. The payoff of finding a quality billing partner can be high, particularly if you need to staff up quickly to meet upcoming needs. That brings us to the pros.

Pros of Outsourced Billing for Orthopedics

Great outsourced orthopedic RCM solutions do exist. The trick is to find a group with orthopedic expertise to provide excellent support for your orthopedics practice or orthopedic surgery center. An external billing partner can offer significant advantages if you find the right fit.

The pros of a great outsourced billing partner:

  • Bigger talent pool and expertise
  • More cost-effective
  • Scalability 
  • More reliable back-office processes
  • Improved KPIs
  • Increased revenue flow

Access to Orthopedic Billing Expertise

One of the biggest positives to hiring an outsourced billing company is the ability to access otherwise unavailable talent. Because orthopedic billing is quite nuanced, coders need specialty-specific credentials like the Certified Orthopedic Surgery Coder certification. Finding revenue cycle managers with years of experience in the specialty is essential so you don’t leak revenue as they learn on the job. 

Once the credentials are nailed down, you can access a much larger talent pool. That may be a massive pro if your practice is in a smaller market where the talent pool is thin. Some local, in-house candidates lack the orthopedic certifications and experience you need.

Cost Effective

Outsourcing done well is incredibly cost-effective. That’s because you’re paying a small percentage of revenue rather than a fixed amount. You can access several certified coders for the same budget it would take to hire one additional FTE. This approach also helps prevent your in-house from being stretched too thin.


Larger external billing partners (as opposed to a one- or two-person shop) are a good option when you need to scale up your team or cover staff transitions. For example, adding temporary staff is especially important in cleaning up old accounts receivable (A/R). Aging A/R is time sensitive; if you can’t go through claims quickly, you miss deadlines and leave money on the table. Large orthopedics practices and surgery centers with lots of aging A/R benefit from a billing partner who can flex with their account.

Modernize Your Billing and RCM

Learn how Gentem’s technology can save your organization time and increase revenue. Schedule a demo with our team today.

Is Outsourcing Billing and RCM Right for Your Orthopedics Practice?

As you contemplate whether you should outsource your medical billing or not, consider your:

  • Internal capacity
  • Hiring budget
  • Talent pool
  • Old A/R that may require specific support

While you are thinking through these details and what team you want to use, gather a comprehensive list of factors that help you make a choice that moves the revenue needle for your practice.

Of course, the overall ROI of outsourcing your billing will depend on the skill of your outsourced team. If you are evaluating providers, make sure you know what you need and how to find it! The Gentem team would love to show you how we help orthopedic practices increase revenue and improve the reimbursement process. Feel free to schedule an intro call with us anytime.

WATCH: Revenue Cycle Tips for Staying Independent

Many physicians are leaving private practice due to rising costs, lower reimbursement rates and staffing shortages. But staying independent is possible with a healthy revenue cycle.

Learn how to run a successful private practice with tips from this 20-minute webinar session.

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5 Must-Know Metrics To Build A Thriving Medical Practice

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