Who we serve · Orthopedics
Billing and payer enrollment for orthopedic and sports medicine practices.
HRI Med takes on billing, denials and payer enrollment for independent orthopedic and sports medicine practices, working claims the way HRI works them for behavioral-health facilities. We enroll the practice, each surgeon and each PA or NP with every payer. Then we bill the surgery, the follow-up, the brace and the injury claim to the rules each one sits under.
Where orthopedic claims get denied: global periods, braces, imaging authorizations and injury claims.
Medicare pays a major surgery as a package. The visit the day before, the operation and the routine follow-up visits for the rest of the global period are all in the one global fee.A The visit where the decision to operate was made is billed with modifier 57. A planned, staged procedure inside that period takes modifier 58, and an unrelated one takes modifier 79.A Without the right modifier, the payer reads it as work already paid for.
Where the surgery happens changes the fee. The place-of-service code on the surgeon's claim decides whether Medicare pays the facility or the office rate, and a hospital outpatient department or a Medicare-participating surgery center is paid at the facility rate.A A surgery center is a separate entity with its own agreement with Medicare, so its facility claim is a separate file from the surgeon's.B
Braces are medical equipment. A physician practice that furnishes them to Medicare patients does so as an equipment supplier, which is an enrollment of its own, filed for each location that furnishes them.C Several common knee and back braces also sit on Medicare's national prior-authorization list.D
Imaging brings its own approvals: a large commercial plan can require prior authorization for an outpatient MRI or CT.E And an injury at work or on the road may not be the health plan's to pay. Medicare pays only after workers' compensation, no-fault or liability insurance that is expected to pay, so the claim has to reach the carrier that owes it first.F
Enrollment first, then every claim the surgery creates.
- Enrollment
- The practice at each location, and every surgeon, physician, PA and NP, with Medicare, Medicaid and each commercial plan you name. Supplier enrollment too, if you furnish braces.
- Authorizations
- Imaging, surgery and brace approvals requested before the date and tracked until the payer answers.
- Surgical claims
- The global period tracked for each patient, so every visit inside it carries the right modifier or is not billed at all.
- Payments and denials
- Each payment matched to the contract rate, and each denial worked to its cause and appealed where owed.
| Piece of work | Fee |
|---|---|
| The practice, with each payer | $350 |
| Each surgeon, physician, PA or NP, with each payer | $250 |
| A clinician's CAQH ProView profile (CAQH now operates as DataSpring), built or repaired | $150 |
| A written answer on whether payers cover one service you are adding | $2,500 |
| Billing and the revenue cycle | By agreement |
Total your own enrollment with the calculator.
Common questions from orthopedic practices.
A new surgeon joins us soon. Where do we start?
With the payers most of your patients carry. The practice is already on file, so each takes one practitioner application at $250, plus $150 if the CAQH profile needs building. Hospital and surgery-center privileges are granted by each facility, separately.
Do you bill the braces we dispense?
Yes. We check that the practice is enrolled as a supplier for Medicare, request the approvals a brace needs, and bill it apart from the visit.
Can you handle workers' compensation and auto injury claims?
Yes. We find the carrier that owes the claim, bill it under that carrier's rules, and send the health plan only what it should pay.
Sources
- Medicare Claims Processing Manual, chapter 12, sections 20.4.2, 30.6.6, 40.1 and 40.2. cms.gov. Read 2026.
- Code of Federal Regulations, 42 CFR 416.2, ambulatory surgical center. govinfo.gov. 2025 edition, read 2026.
- Code of Federal Regulations, 42 CFR 424.57, equipment supplier standards. govinfo.gov. 2025 edition, read 2026.
- CMS, Required Prior Authorization List for medical equipment and orthotics. cms.gov. Updated 2026.
- UnitedHealthcare, commercial radiology prior authorization. uhcprovider.com. Other plans set their own lists. Read 2026.
- Code of Federal Regulations, 42 CFR 411.20, Medicare as secondary payer. govinfo.gov. 2025 edition, read 2026.
Send us your surgeons, locations and payers.
We check each against your enrollment and show you the gaps. No patient information needed.
Add any surgeon or physician assistant who starts soon, with a start date if you have one.