The Prescription for Surgeons is Specialized Billing
Medical billing is a crucial health care service that supports physicians by submitting and collecting the payments from insurance companies and patients. One needs to be an expert to ensure that the bills are collected fully and in a timely fashion. It is quite common for over 20% of a practice’s potential revenue to remain unclaimed because of improper coding and weak collection strategies.
Outsourcing medical billing is growing in popularity as an approach for addressing this tremendous loss of practice income. The range of outsourcing options runs from extremely large organizations to individual freelancers who work from home to provide medical billing services.
Although the complexity of basic medical billing is quite high, it pales in comparison to the complications that come to play for surgical billing. Successful navigation of the payers’ policies and procedures for paying surgery claims requires specialized knowledge that comes from experience with billing for surgeons.
As the cost of providing surgery related healthcare services continues to rise, medical institutions and surgical practices cannot afford to leave revenue uncollected by billing companies or freelancers that are not knowledgeable in surgical billing. It is also important to keep in mind some companies may promote themselves as large surgery billing service providers but in reality they sub-contract the surgery billing to freelancers who work from home. Hiring such companies will lead to lost revenue because of the lack of proper process, controls, and training.
Deep familiarity and comfort with surgical procedures and terminology does not come from serving one or two surgeons. Surgical billing success requires both broad and deep expertise in order to collect all of the money owed the surgeon and successful appeal claims which have been denied or answer questions the payers may have about a claim.
A company that does not encompass a wide range of surgery billing experience will find it difficult to track underpayments since multiple procedure rules and surgical procedures have significantly more complicated contractual adjustments than a typical family doctor or internist’s claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in billing for surgeons.
The surgery-driven difficulties of medical billing encompass patient billing also. A surgeon’s patient balance process is more challenging because most of the balances are quite sizeable. Coupling this with the difficulties of explaining to a patient their complicated Explanation Of Benefits and the surgical terminology on their bills drives the need for patient collection specialists that have a strong expertise in surgical billing. If patient are not handles with care surgeons will see their patient collections fall and their patient complains rise - not a good combination.
To avoid all these billing related pitfalls surgeons need to utilize specialized surgery billing services. It is not advisable for an internist to perform surgery, similarly someone without training in surgical coding and surgical billing is not qualified to offer reliable billing services for surgeons.
Copyright 2008 by Carl Mays II
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