Orthopedic Billing Services in Florida That Simplify Your Revenue Cycle
Orthopedic practices in Florida partner with Transcure to achieve:
- Accurate billing for AHCA Medicaid orthopedic services and authorization rules
- Workers’ compensation orthopedic claim handling under Florida state fee schedules
- No-fault PIP billing compliance for accident-related orthopedic treatments statewide
- Out-of-network reimbursement negotiation with major Florida commercial insurers
- Surgical center billing aligned with Florida Ambulatory Surgery Center regulations
- Audit-ready documentation meeting the Florida Board of Medicine requirements
What Billing Hurdles Are Florida Orthopedic Practices Battling Today?
Florida orthopedic practices must navigate unique state-driven payer behaviors and patient demographics that directly impact reimbursements.
- Seasonal Patients & Medicare Coordination (Snowbirds): High seasonal Medicare population causes dual-state coverage headaches, Medicare Advantage network gaps, and telehealth licensing issues..
- Medicare Advantage Market Saturation: Florida has one of the nation’s highest Medicare Advantage enrollments, restricting orthopedic networks and reimbursement flexibility.
- High Volume of Tourist Injuries: Non-resident patients require complex eligibility checks and cross-state payer coordination for orthopedic emergency care.
- PIP Reimbursement Limit Issues: Florida’s no‑fault law (§627.736) caps PIP reimbursements and often results in under‑payments or coding disputes for orthopedic treatments.
How Does Transcure Solve Orthopedic Billing Challenges In Florida?
Transcure fixes the claim-level problems that actually block payment for Florida orthopedic practices.
Orthopedic-Specialist Coding and Modifier Team
1100+ certified coders using CODIN apply precise CPT/ICD-10/modifier combinations for complex joint, spine, and fracture procedures, reducing technical denials pre-submission.
Payer-Specific Claims Scrubber (Pre-Submission Edits)
Our AI agent CLAIR validates claims against Florida carrier edits and payer quirks, preventing predictable rejections before insurers receive them.
Daily AR Escalation and Focused Follow-Up
A team of A.R. specialists using ARIS chases aged orthopedic claims, escalates stuck accounts, and secures outstanding payments through payer-specific outreach.
Seasonal-Provider Credentialing Coordination
We manage credentialing flags and payer enrollments for locum or snowbird surgeons to prevent claim rejections tied to provider enrollment gaps.
Medical-Lien and PI Claim Routing
Transcure tags and routes personal-injury claims for timely lien filing and post-settlement remittance, minimizing payment loss from attorney coordination delays.
Implant Audit Prevention and Reconciliation
We match operative implant SKUs to billed charges and attach required documentation to claims, reducing retrospective audits and recoupments.
Our Success in Numbers
Which Florida Cities Count on Transcure for Orthopedic Billing Excellence?
Jacksonville, Florida
Miami, Florida
Tampa, Florida
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Orlando, Florida
St. Petersburg, Florida
Port St. Lucie, Florida
Cape Coral, Florida
Hialeah, Florida
Tallahassee, Florida
Fort Lauderdale, Florida
Is an In-House Billing Team Costing Florida Orthopedic Practices More Than It Should?
Managing orthopedic revenue cycle operations internally means carrying payroll overhead, staff turnover risk, and software subscriptions. With Transcure, Florida orthopedic practices shift to a simple 5% of collections model, removing staffing costs while maintaining consistent reimbursement performance.
In Florida, a typical in-house billing setup for an orthopedic clinic often requires a billing/coding specialist (~$47,000), a revenue cycle follow-up specialist (~$64,000), and a billing manager (~$95,000). After adding approximately 30% for benefits and $6,000 in billing software and system expenses, internal RCM operations can exceed $300,000 annually.
For an orthopedic practice collecting $500,000 per year, Transcure’s service fee totals $25,000, creating an estimated $275,000+ in annual savings.
Which Counties in Florida Trust Transcure for Orthopedic Billing Services?
Miami-Dade County
Broward County
Palm Beach County
Orange County
Hillsborough County
Pinellas County
Which Complex Orthopedic Procedures In Florida Does Transcure Handle Billing For?
These are some of the most complex orthopedic procedures Transcure manages billing for across Florida practices:
Primary & Revision Total Hip Arthroplasty
We ensure correct coding, implant charge capture, and audit-ready claims for multiple implants, DRG/ICD-10 complexity, and SKU reconciliation.
Primary & Revision Total Knee Arthroplasty
As bundled services and high implant costs demand precise modifiers and payer rules, our dedicated team prevents underpayment and supports appeals when needed.
Multi-level Spinal Fusion with Instrumentation
Transcure optimizes CPT sequencing, device billing, and payer justification documentation for numerous CPTs, hardware charges, and medical-necessity scrutiny.
Complex Trauma Reconstruction (pelvic & peri-articular fractures)
Emergency care coding, staged surgeries, and implant tracking create billing hurdles for practices, so Transcure consolidates episodes and submits accurate claims.
Limb-salvage & Oncologic Reconstruction Procedures
High-cost implants, grafts, and extended hospital stays complicate reimbursement. Transcure manages DRG validation, charge capture, and denial avoidance strategies.
Reverse & Complex Shoulder Arthroplasty
Specialty implants, laterality and modifier rules, and rehab bundles require exact billing, which we do by capturing implant costs and securing appropriate reimbursements
Why Do Florida Orthopedic Practices Choose Transcure as Their Billing Partner?
Transcure goes beyond claim submission by delivering Florida-focused billing expertise that protects orthopedic revenue and keeps cash flow predictable.
Dedicated Orthopedic Billing Lead
Each practice receives a single orthopedic-trained billing lead overseeing claim accuracy, denial trends, and monthly performance reviews tailored to Florida payer behavior.
Florida Payer Resolution Desk
Our team maintains direct communication channels with major Florida commercial insurers and Medicaid plans to accelerate reprocessing of denied orthopedic claims.
Provider Enrollment & Revalidation Support
Transcure manages Florida payer enrollment, recredentialing timelines, and retroactive claim submissions to prevent lost reimbursements from enrollment lapses.
Patient Balance Recovery Program
We implement structured patient statement cycles and payment follow-ups designed for Florida’s high-deductible and retiree-heavy patient population.
How Does Florida’s Pip “Emc” Rule Uniquely Disrupt Orthopedic Billing?
Florida’s no-fault PIP law requires an Emergency Medical Condition (EMC) determination to unlock the full benefit level; without it, providers often receive only a $2,500 cap instead of higher coverage. This statutory split and strict timelines leave many accident-related orthopedic claims underpaid despite valid clinical care.
At the billing stage, this causes widespread partial payments, frequent payer pends, and repeated resubmissions as EMC status is clarified or medical records are escalated. Expert claim-level filing and targeted follow-up by Transcure are essential to convert pended PIP files into full reimbursement.
Which Orthopedic EHR Systems Does Transcure Integrate With?
Transcure connects effortlessly with over 30 orthopedic-focused EHR and practice management platforms
What Do Florida Orthopedic Practices Say About Working With Transcure?
Explore how orthopedic groups across Florida describe Transcure’s impact on their collections, claim turnaround, and overall billing performance through real partner feedback.
Jackie Judd
Practice Manager
Wilson Creek Internal Medicine
As a practice manager, I was looking to streamline the medical billing process. I tried other companies, but they were all complicated and took too much of my time. Fortunately, I found Transcure. They excel in tailoring solutions to fit my requirements.
Amber Vaughan
Office Manager
Idaho Kidney & Hypertension Institute
We are a large practice with 15 providers. Transcure has been working with us for the last 5 years. This billing company has been a great asset to us. I work with Transcure and they provide everything I ask for. The team is friendly and very pleasant to work with.
Ashlee Rose
Practice Manager
Harding Memorial Healthcare
We’ve been working with Transcure for 8 years now and I just wanted to say how happy we are with their services. They always get back to us quickly and are very easy to work with. They get my bills paid in record time and help us to generate millions in revenue.
Frequently Asked Questions (FAQs)
How does Florida’s PIP “EMC” rule change how orthopedic claims get paid?
If a motor-vehicle injury isn’t documented as an Emergency Medical Condition (EMC), PIP payments can be limited to the $2,500 cap. That distinction and the related 14-day/treatment timing rules frequently cause partial payments or pends on orthopedic trauma claims. They also require precise claim coding and timely resubmission when EMC status is clarified.
How does Medicare Advantage penetration in Florida change orthopedic billing strategy?
Florida’s AHCA has program-specific coverage rules, prior-authorization processes, and provider-enrollment requirements that vary by service (including ortho DME/implant authorizations). Missed authorizations, incorrect Medicaid plan routing, or lapsed enrollments cause denials that must be appealed or resubmitted per AHCA guidance.
What Florida Medicaid (AHCA) quirks should orthopedic practices expect at claim submission?
High MA enrollment in many Florida counties means more patients are in plans with unique prior-auth rules, bundled payment edits, and narrow networks. Billing companies must validate MA plan details up front, apply plan-specific coding/modifiers, and run focused appeals when MA plans underpay or deny.
How does a billing partner prevent lost revenue from high-cost implants and prevent audit recoupments?
At the claim level, Transcure enforces implant charge capture: match SKU/invoice to operative notes and attach device documentation. Also, we bill correctly HCPCS/CPT and modifiers and reconcile vendor consignment records to maximize implant reimbursement.