You are an office manager working in an orthopedist office. You are responsible for filling out the insurance billing forms and processing any denials. While reviewing the denials, you find they are in fact billable services. The issue is a lack of understanding from the insurance processer due to not having a medical terminology background. Start your conversation with the processer regarding services offered and using medical terms, and explain what the services are in understandable terms
Office Manager: Hello, [Processer's Name]. I noticed that there have been some denials for billable services, and it seems to be due to a misunderstanding of the medical terminology involved. I'd like to take some time to explain the services we offer and help you understand the terminology so that we can avoid these denials in the future. Are you available to discuss this now?
Processer: Yes, I'm available. I appreciate your willingness to help me understand. I understand that my lack of medical terminology knowledge is causing these denials. Could you please explain some of the services to me in understandable terms?
Office Manager: Of course! Let's start with some common orthopedic services we offer:
1. X-ray: This is a diagnostic method that uses electromagnetic radiation to create images of bones and joints. It helps us identify fractures, dislocations, or other conditions affecting the skeletal system.
2. MRI (Magnetic Resonance Imaging): MRI uses a magnetic field and radio waves to produce detailed cross-sectional images of the body. It provides us with clear images of tissues, muscles, and ligaments, allowing us to diagnose conditions such as torn ligaments, muscle strains, or joint disorders.
3. Physical Therapy: Physical therapy involves exercises, stretching, and specialized techniques to help patients recover from injuries or surgeries, improve mobility, and reduce pain. Physical therapists work closely with patients to develop personalized treatment plans.
4. Arthroscopy: Arthroscopy is a minimally invasive surgical procedure that allows us to visualize, diagnose, and treat joint problems. It involves inserting a small camera called an arthroscope into the joint through a small incision. Surgeons can then assess and repair damaged structures like cartilage or ligaments.
5. Orthotic devices: Orthotic devices are braces, splints, or other supports used to aid in the treatment and recovery of certain orthopedic conditions. They provide stability, correct alignment, and reduce pain by supporting or immobilizing specific body parts, such as the foot, ankle, knee, or back.
I hope this gives you a better understanding of the services we offer. Is there anything specific you would like to know more about?
Processer: That explanation definitely helps, thank you! I have a better grasp of these services now. Would it be possible to provide me with a list of common medical terms related to orthopedics that often appear on the insurance forms? I would like to familiarize myself with them to improve my understanding.
Office Manager: Absolutely! Here are some common orthopedic terms that you might encounter on the insurance forms:
1. Fracture: A broken bone.
2. Dislocation: The displacement of a bone or joint from its normal position.
3. Tendon: A fibrous connective tissue that connects muscle to bone.
4. Ligament: A fibrous connective tissue that connects bones to each other, providing stability to joints.
5. Sprain: An injury to ligaments caused by a sudden twist, stretching, or tearing.
6. Strain: An injury to the muscle or tendon caused by overstretching or excessive use.
7. Osteoarthritis: A degenerative joint disease characterized by the breakdown of cartilage and bone.
8. Rheumatoid arthritis: An autoimmune disease that causes chronic inflammation in the joints.
9. Rotator cuff tear: A tear in the group of tendons and muscles that surround the shoulder joint.
10. Carpal tunnel syndrome: A condition caused by pressure on the median nerve in the wrist, leading to pain, tingling, and numbness in the hand and fingers.
I hope this list helps you familiarize yourself with some common terms. Remember, if you ever come across any unfamiliar terms, feel free to ask for clarification. It's always better to ask and understand than to assume and risk denials.