Surgical Billing Requires a Specialized Billing Service
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.
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.
Medical billing is a highly complex area and it requires experience-based knowledge and expertise to contend with insurance companies. When it comes to surgical billing, the situation gets even more complex. Such complexity can be handled only by a company that is staffed with well trained surgery billing professionals. The medical billing specialist must be familiar with the specific codes and rules that make up the world of surgery billing.
With surgeons facing ever increasing costs they must insure that money is not being left on the table because they have a billing company that is not a surgical billing expert. Surgeons must also be aware that that many billing companies that claim surgery billing expertise actually outsource their surgery billing to work at home billers. Situations like this are fraught with the risk since the remote workers are not working in a controlled and monitored environment.
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.
The bottom-line is that is not worth the risk for a surgeon to use a billing company that is not as focused as he or she is on surgery. Just as a patient should not go to a family doctor for surgery, a surgeon should not go to a generalist billing company for medical billing.
Copyright 2008 by Carl Mays II
Filed under: Outsourcing