How to Start an
Orthopedic Practice

Define the Orthopedic Care Model

Orthopedic surgery practices manage operative care and commonly need hospital or ASC privileges, case scheduling, implant relationships, preoperative processes, and postoperative follow-up. Non-surgical sports medicine models may emphasize diagnostics, injections, rehabilitation coordination, and return-to-activity care.

Define what can be safely delivered at launch and build referral, escalation, and continuity protocols around that scope.

Privileges and Surgical Operations

Facilities review education, licensure, training, case experience, peer references, and quality history. Keep credentialing files current and confirm call coverage, emergency transfer, infection control, implant, and postoperative requirements.

An ASC can improve workflow, but ownership and referrals require a detailed Stark Law, Anti-Kickback Statute, state licensure, and transaction analysis.

• ✓Verify facility privilege criteria and renewal requirements.
• ✓Document training, case logs, references, and quality data.
• ✓Review ASC ownership with healthcare counsel.
• ✓Align perioperative and emergency protocols with facility rules.

Imaging, Fluoroscopy, and Diagnostic Workflow

In-office X-ray can support efficient evaluation when the practice complies with radiation registration, safety, personnel, supervision, maintenance, and payer rules. Fluoroscopy may add further operational and safety requirements.

Build processes for ordering, image acquisition, interpretation, reporting, quality assurance, and transfer to outside facilities. Equipment selection should follow anticipated patient volume and clinical need, not only a financing offer.

DME Dispensing and DMEPOS Compliance

Braces, boots, supports, and other DME can improve patient convenience, but dispensing creates inventory, documentation, fitting, training, supplier, and billing responsibilities. Medicare DMEPOS enrollment has its own compliance requirements for eligible suppliers.

Do not assume every item is billable or that a clinical order alone supports a claim. Verify medical necessity, coverage, supplier requirements, patient responsibility, and recordkeeping.

Physical Therapy and Ancillary Services

Physical therapy integration may improve coordinated care, but ownership, referral, supervision, location, and billing arrangements need Stark Law and state-law analysis. The in-office ancillary services exception is fact-specific and should not be assumed to apply.

Create meaningful clinical choice and clear referral documentation. Care coordination should serve the patient rather than channel referrals based on financial pressure.

Coding, Billing, and Specialty Claims

Common code families include 99213 through 99215 for visits, 27447 for total knee arthroplasty, and 29881 for certain knee arthroscopy services, subject to current coding rules and supporting documentation. Establish charge capture, modifier, global-period, implant, and denial workflows with qualified billing leadership.

Workers compensation and auto injury claims have distinct authorization, billing, documentation, lien, and payment processes. Staff them separately from ordinary commercial claims where possible.

• ✓Use specialty-specific coding edits and claim review.
• ✓Track global periods and postoperative billing rules.
• ✓Build separate workers compensation and auto-injury workflows.
• ✓Audit denials and documentation patterns monthly.

PRP and Regenerative Injections

PRP and other regenerative services may be clinically considered in appropriate circumstances, but payer coverage is variable and marketing scrutiny is high. Many practices use cash-pay models.

Use evidence-aware protocols, informed consent, truthful marketing, product traceability, and documentation of medical rationale. Avoid promising regeneration or guaranteed recovery.

Technology and EMR Selection

Orthopedic EMRs such as Modernizing Medicine and Nextech may offer specialty templates, imaging workflows, procedure documentation, and reporting. Evaluate usability, interoperability, billing tools, patient communication, implant support, and implementation capacity.

Templates should improve documentation without creating copy-forward records that obscure the patient-specific assessment.

Financial Plan and Startup Costs

Model leasehold improvements, imaging, equipment, implants and supplies, IT, malpractice, staffing, legal work, credentialing, and months of working capital. Large purchases should have a volume, utilization, maintenance, and reimbursement case.

Track provider capacity, surgical conversion, collection rate, days in accounts receivable, imaging utilization, DME margin, no-shows, and referral-source performance.

• ✓Plan for credentialing and reimbursement delays.
• ✓Separate surgery, clinic, imaging, and DME economics.
• ✓Evaluate leasing versus buying capital equipment.
• ✓Maintain conservative working-capital assumptions.

Compliance, Referrals, and Quality

An orthopedic compliance program should cover privacy, billing, referrals, imaging safety, DME, therapy, conflicts, informed consent, infection control, incident response, and professional liability. Regular chart and claims audits help identify patterns early.

Build referral relationships through clinical communication, access, and quality rather than inducements. Give clinical leaders authority to correct unsafe or noncompliant practices.

• ✓Audit charts, procedure documentation, and coding.
• ✓Review referral and financial relationships with counsel.
• ✓Train staff on privacy, safety, escalation, and complaints.
• ✓Maintain quality review and corrective-action records.