AI-Powered RCM Built for Orthopedic Practices
From surgical global periods and implant/DME billing to modifier accuracy and denial management — SCALE delivers revenue cycle intelligence purpose-built for orthopedic groups, ASCs, and MSOs.
Surgical & Global-Period Coding
Staged procedures and modifiers 58/78/79
Implant & Hardware Billing
Implant logs, invoices & payer carve-outs
DME & Bracing
In-office DME dispensing, KX & RT/LT modifiers
Prior Authorization
Joint replacement, spine & advanced imaging
Real-Time RCM Analytics
Live dashboards via SCALE's analytics platform
Orthopedic billing is uniquely complex. We know it cold.
High-complexity care comes with high-complexity billing — and most generalist RCM vendors aren’t equipped to handle it. SCALE is.
Global-Period & Staged-Surgery Complexity
Orthopedic surgery relies on global-period and staged-procedure modifiers (58/78/79) that drive denials when misapplied.
Implant & DME Revenue Leakage
Implant invoices, hardware carve-outs, and in-office DME dispensing are frequently under-captured.
High-Cost Authorization Burden
Joint replacement, spine procedures, and advanced imaging carry intensive prior-auth requirements that stall revenue.
How SCALE solves it
Orthopedic Prior Authorization
We manage joint, spine, and advanced-imaging authorizations end to end — including peer-to-peer review.
Ortho Coding & Charge Capture
Automated review flags global-period, modifier, and implant under-capture across surgical claims.
Orthopedic Denial Management
Payer-specific appeal templates for global-period, modifier, and medical-necessity denials.
Implant & DME Revenue Integrity
Accurate implant, hardware, and in-office DME capture with KX/RT/LT modifiers.
End-to-end RCM for every Orthopedic encounter
Automation handles volume and velocity. Our experts handle exceptions, edge cases, and strategic optimization — creating a closed-loop system that continuously improves performance over time.
Discovery & Audit
We analyze 90 days of claims data to identify coding gaps, denial patterns, and authorization bottlenecks specific to your practice.
EHR Integration
Seamless connection to your EHR and practice-management system — no new software for your team to learn or manage.
Go-Live & Handoff
SCALE's dedicated team takes over day-to-day RCM operations with transparent reporting from day one.
Continuous Optimization
Monthly performance reviews, payer-policy monitoring, and AI-driven recommendations keep revenue growing over time.
Representative results across SCALE clients
Representative results across SCALE Healthcare clients. Individual outcomes vary by organization size, payer mix, and baseline RCM maturity.
Reduction in average days to pay across SCALE-managed client portfolios
Reduction in cost-to-collect through AI automation and workflow optimization
Reduction in A/R aging beyond 90 days through proactive denial management
Reduction in overall denial rates powered by DenialShield predictive scoring
Works inside the EHRs your team already uses
Let’s build your Orthopedics RCM roadmap together
Book a free 30-minute strategy call with a SCALE Orthopedic specialist. We’ll review your current denial rates, authorization backlog, and coding performance — at no cost.