Surgeons Need a Specialized Surgical Billing Services

by Carl Mays II

Medical practices lose money each and every day (often over 20 percent of their realizable income) because they are not employing medical billing specialists, technologies, processes and management that can stand toe-to-toe with the insurance companies.

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.

In thinking through the billing options available, it is crucial to understand that medical billing is complicated and requires deep expertise and broad experience. When a specialty is involved, such as surgical billing, the requirements for success become even harder to achieve. Success requires that the medical billing company have a team that is well versed with the complex rules utilized by insurance companies to adjudicate surgical medical claims.

The choice of an experience billing provider has become all the more important for surgeons as they watch their cost rocket upwards. With their margins shrinking they must be confident that their surgical billing service is collecting every dollar the surgeon is owed. Selecting the proper medical billing service is made all the more difficult by the fact that many companies claiming to be experts in billing for surgeons actually do not do the billing themselves, but outsource the work to other vendors that are based in India or work from their homes.

A key battle ground in the struggle to collect all of the money due a surgeon is appealing denied claims and answering extremely specific and technical questions about procedures and diagnoses. Success In this arena requires significant experience, the kind that is only gained from serving many surgeons for many years.

Good surgery billing requires the ability to track underpayments. This is more complicated than typical medical billing because of the rules around multiple-procedures. This complication often exceeds the capabilities of the billing software used by generalist billing companies. This is a critical failing since proper pursuit of underpayments can increase a surgeon’s collections by 7 to 10 percent.

It is not only insurance billing that is more complicated for surgeons; patient billing is also more difficult. The patients often have high balances, complicated explanations from their payers and do not understand all of the invoices they are receiving from their surgeon, the hospital or ASC and the anesthesiologist. A billing company that has strong surgical billing experience has spoken with patient about these topics many times before. A less skilled patient collection effort could leave the surgeon with less money and unhappy patients.

The safest way for a surgeon to navigate the medical billing land mines outlined in this article I to travel the medical billing battlefield with a surgical billing service that has deep and proven expertise in traversing the surgery billing hazards. Family doctors should not be performing surgery and generalist medical billing companies should not be providing medical billing services to surgeons.

Copyright 2008 by Carl Mays II

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