The problem
Denials keep climbing. Kodiak Solutions, whose data are mostly hospital-based, reported that payers initially denied 11.81% of claims in 2024, and that missing-authorization and medical-necessity denials accounted for virtually all of the increase from 2024 to 2025. Our guide to common orthopedic claim denials maps ten denial types to their causes.
Many denials are never appealed. KFF reported in January 2026 that only 11.5% of Medicare Advantage prior authorization denials in 2024 were appealed, though 80.7% of appealed denials were overturned at least in part. In orthopedics, one denied joint replacement can outweigh dozens of denied office visits, and every appeal has a deadline, as our appeal guide shows.
How it works
Read the notes: Rette’s AI agents connect to athenahealth or eClinicalWorks and read operative and clinical notes directly. Using another EHR? Ask about your EHR.
Flag gaps before coding: Rette flags documentation gaps in the note and suggests CPT and ICD-10-CM codes and modifiers for your coders to review.
Validate before submission: Claims are checked against NCCI edits and Medicare NCD and LCD rules before they go out.
Work denials from one queue: Denials and appeals sit in one prioritized work queue with prior authorization and workers’ compensation, so staff see what needs attention first.
What you get
Pre-submission checks against NCCI edits and Medicare NCD and LCD rules
Documentation gaps flagged before coding and before submission
Code and modifier suggestions that coders review before anything is billed
One prioritized queue for denials and appeals, shared with prior authorization and workers’ comp
A free denial code decoder and payer policy lookup at policy.rette.ai
Built for orthopedics
Rette is built with orthopedic surgeon advisors. Orthopedic denials cluster in a few reason codes:
Bundling: CO-97 can follow chondroplasty billed with a meniscectomy on the same knee, or a related visit inside a 90-day global period.
Medical necessity: CO-50 can rest on an NCD; NCD 150.9 excludes arthroscopic debridement of an osteoarthritic knee when the patient presents with knee pain only.
Authorization: CO-197 means a required approval wasn’t on file for the service billed, often because it covered a different code, side or date.
Missing data: CO-16 calls for corrected data and a new claim, not an appeal.
Measurement: track denial rate by count and by dollars, because high-dollar surgical denials can pull the two apart.
Frequently asked questions
Should we appeal a denial or correct and resubmit?
Ask whether the payer acted on missing or wrong data or made a judgment you can rebut. A CO-16 with a remark code usually needs corrected data and a new claim. Medical-necessity, bundling and authorization denials, such as CO-50, CO-97 or CO-197, usually need records and an appeal. Original Medicare redeterminations are due within 120 days of receiving the initial determination.
Which denials can Rette help prevent?
Rette works before submission: it flags documentation gaps before coding, suggests codes and modifiers for coder review, and checks claims against NCCI edits and Medicare NCD and LCD rules. Those checks target denials that start in the note or the code set, such as bundling, modifier, diagnosis-mismatch and medical-necessity denials.
How do we get started?
Request a demo, or start with a free denial audit. Rette connects to athenahealth or eClinicalWorks, so there is no data migration and no new system for staff to learn; for other systems, ask about your EHR. Pricing and go-live timing are confirmed on a call.
Related guides
Read More
Denials & Appeals
The Most Common Orthopedic Claim Denials in 2026, and How to Prevent Them
Oct 14, 2026
Read More
Denials & Appeals
How to Appeal a Medical-Necessity Denial for a Knee or Hip Replacement
Oct 14, 2026
Read More
RCM Benchmarks & Strategy
Orthopedic RCM Benchmarks for 2026: Days in A/R, Clean Claim Rate, Denial Rate and Net Collection Rate
Oct 14, 2026
Key terms
Rette reads the operative note in the EHR you already use, suggests codes and checks claims against payer and NCCI rules before submission.