Medical billers and medical billing services are the financial life blood of a practice. Practices that do not have the right medical billing expertise in their corner can easily lose more than 20 percent of their practice’s potential revenue.
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.
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.
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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