Surgical bundling and prior auth failures cost ortho practices recoverable revenue every day.
Orthopedic procedures involve some of the most complex coding in medicine, multi-procedure reductions, surgical prior authorization, global-period rules, implant billing, and modifier-heavy claims. Manual billing teams catch a fraction of the errors. Ember catches all of them.
Trusted by specialty groups and health systems
Where orthopedics revenue leaks
Top orthopedics denials Ember resolves
Ember addresses the medical necessity and authorization issues that most often interrupt payment for orthopedic care.
01 · Medical necessity
Claims deny when payer-specific requirements are not supported clearly in the record.
Workers' compensation payer complexity, multi-procedure bundling rules, and global-period or split-care billing can all change what documentation is required. Ember reviews the claim and record together to identify gaps before submission and support appeals when needed.
Workers' comp · Bundling · Global periods02 · Prior authorization
Surgery is delayed or denied when authorization requirements are missed.
Orthopedic procedures often require authorization before the date of service. Ember helps teams identify surgical prior authorization requirements, track the necessary documentation, and reduce missing-auth denials.
Surgical prior authorizationThree engines.
One source of truth.
Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer. Built for the surgical complexity and implant billing orthopedics requires.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every encounter and provider.
D. Castellano
Encounter #O-33915
02 · Audit
Coding Engine
Reviews 100% of encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.
Append modifier 59 — distinct procedural service
CMS NCCI PTP · confidence 0.96
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the applicable LCD/NCD policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #O-33915 · Denial CO-50
The total knee arthroplasty meets medical-necessity criteria under LCD L36577 with documented conservative-care failure, per contract §6.1…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for orthopedic practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the surgical bundling issue before the claim leaves.
Ember reviews every encounter against coding standards, payer surgical policy, and your contracts. Bundling errors, authorization gaps, and joint replacement medical-necessity issues are flagged before submission.
- 1
Ingest the encounter
Pulls operative reports, procedure codes, and implant documentation from your EHR and surgical scheduling system.
- 2
Validate against rules
Checks multi-procedure reduction rules, add-on code bundling, global-period requirements, and implant billing against each payer's specific policies.
- 3
Recommend with citation
Returns the suggested correction tied to the exact payer policy, NCCI edit, or contract term.
- 4
Educate the provider
Coding patterns drive provider-level coaching, so operative note documentation and implant billing accuracy improve across every surgeon.
Append modifier 59 — distinct procedural service
CMS NCCI PTP · confidence 0.97
+23%
Clean-claim rate
100%
Encounters reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves operative reports, implant invoices, and conservative-care records, references payer policy and contract terms, drafts the appeal, and tracks it through adjudication.
Medical necessity
Missing modifier
Bundling reduction
Prior auth not on file
Joint replacement appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per appt
The full revenue cycle
From eligibility to adjudication. Covered.
Audit and appeals are the workhorses, but Ember protects orthopedic revenue at every stage of the cycle.
Eligibility Verification
Confirms active coverage and surgical benefit structure before the case, including workers' compensation and payer-specific requirements.
Prior Authorization
Checks auth requirements in real time for joint replacement and complex surgical procedures, generates medical-necessity documentation, and submits to payer portals automatically.
AI Medical Coding
Reviews 100% of encounters, surgical codes, global-period context, and implant billing against national standards and payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching multi-procedure bundling errors, authorization gaps, and medical-necessity issues before they generate write-offs.
Denial Management
Full appeal lifecycle for orthopedic bundling disputes, authorization failures, medical necessity denials, and modifier errors, tracked to adjudication.
Underpayment Recovery
Parses contracts to model what each surgical and implant claim should pay, then surfaces line-item underpayments at scale.
High-value surgical revenue, recovered
-57%
denial rate
-45%
cost to collect
100%
encounters audited
3 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
- 65% less manual effort, as reported by customers
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
See what your ortho practice is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.