The Prescription for Surgeons is Specialized Billing
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.
Medical billing outsourcing is an accelerating trend that medical practices and facilities are utilizing to level the playing field between them and the insurance companies. Potential outsourcing options go from individual medical billers working from their home to medical billing services that with thousands of providers.
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.
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 typical sort-coming with medical billing services that do not specialize in surgery billing is the inability to properly track and pursue insurance underpayments. These underpayments cost most surgeons about 10% of their potential income. If a medical billing company does not understand the mult-procedure rules and have a system that can track underpayments (and does not flag every payment on a second procedure as underpaid), they will find it difficult to capture this lost revenue is a systematic manner.
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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