Aside from the exceptionally busy business of cosmetic or reconstructive surgery, the hardest thing for surgical practices is adhering to the billing and coding guidelines and best practices. Let’s be honest: due to the multiple procedure payment reduction rules, the various levels of wound repair codes, co-surgeries, the need to use the right E/M modifier, and surgical codes, getting the plastic surgery medical coding can be quite the challenge.
Taking the above into consideration, any errors in these and their related medical codes can cause your practice unforeseen delays when it comes to collecting payments and insurance claims. These errors can be a direct cause for a loss of revenue, time, and patient care, as well as delaying claims or even having them outright denied.
Plastic and reconstructive surgical practices need to be very aware of this and, as such, should take extra care and due diligence when it comes to billing and coding guidelines.
Fortunately for your practice, Fortis medical billing for plastic surgery is here to help you bolster your revenue and collections streams, all the while keeping your practice admin in the best possible condition.
Let’s take a look at some of the challenges related to the billing aspects of plastic surgery that plastic surgery billing services from Fortis can assist you with.
Billing Challenges Related to Plastic Surgery
Successful billing for any surgical practice requires an in-depth knowledge and understanding of coding and billing guidelines, insurance coverage, medical necessities, required documentation, and patient responsibilities. This knowledge is of the utmost importance if you are going to run a profitable and successful practice.
With the constantly changing and evolving coding around plastic surgery it can be challenging to stay up-to-date with all the changes, to ensure that your practice is not having claims denied. The variety of services that are used during plastic surgery, such as anesthesia and post-operative care, and everything in between, can make coding for billing purposes quite a headache.
What makes the coding issue even more complex are patient consent and confidentiality, which could raise some legal and ethical concerns, making the practice of coding even more complex and cumbersome.
The coding guidelines for surgical procedures vary depending on the type and location of the procedure, the patient’s specific case, as well as any additional procedures related to the surgical session. Staying up-to-date with the correct coding requirements will ensure accurate billing and full reimbursements.
Prior authorization for plastic surgery procedures can be a time-consuming and complex process that requires the submission of medical documentation and records to the insurance company. Furthermore, because of the lack of standardization in this process between different insurance companies this can lead to both confusion and inconsistencies.
Limitations regarding coverage for plastic surgery procedures can make it rather difficult to get the necessary pre-authorization which can make the entire process a rather challenging and frustrating one. The patient must make sure that they are covered by the insurance providers before undertaking any such procedures. Out-of-pocket plastic surgery is a very expensive endeavor.
Insurance Coverage Limitations
Generally speaking, insurance companies only cover plastic surgery that they deem necessary, and tend to not approve claims that are wholly elective or strictly cosmetic surgeries. As a general rule of thumb, insurance companies will only cover plastic surgery costs if they deem it medically necessary for treating a medical condition or an injury.
Insurance companies are most likely not going to cover procedures such as breast augmentation or liposuction, as they deem these procedures as strictly cosmetic and not a necessary or essential medical procedure. There are however some cases that allow for part of the cost of the procedure to be covered, as they have both cosmetic and reconstructive components.
Compliance risk, in this regard, refers to the potential for practices to violate regulatory requirements or ethical standards regarding the billing and coding practices. Incorrect coding, unbundled services, overbilling, fraudulent or abusive practices, and billing for non-covered services are the risks that a practice runs here.
Failure to comply with the guidelines set out by the Centers for Medicare and Medicaid Services (CMS) and private insurance payers can result in material financial penalties, legal action, and reputation damage. A virtual practice killer and reputation destroyer. That is not what you want to accomplish.
To mitigate the negative repercussions of compliance risks, a practice should establish and affirm an effective compliance program that includes: regular training of staff, auditing, and a strict monitoring of coding and billing activities and practices. It is important that staff know and understand the vital importance of adhering to the coding and billing guidelines that have been established.
Key Components for Mastering Plastic Surgery Billing
Understanding the key components that make up the art of plastic surgery billing need to be properly understood to make sure that your practice is enhancing its revenue cycle, and making the most out of insurance claims. These components are:
- Accurate Coding for Maximum Reimbursement
Essential for reducing denials and maximizing reimbursements, accurate coding is the cornerstone of getting your money paid to you. Accuracy and completeness, as well as staying up-to-date with the relevant codes will ensure that you get what is owed to you, and outsourcing these activities could save your practice a ton of potentially lost revenue.
- Effective Claim Submission and Follow-Up
Crucial to the claim submission process, effective submissions and follow-up can become the lifeblood of your practice. To get on the better side of claims submissions, try the following recommendations:
- Use electronic health records (EHR) for accurate and timely submissions
- Identify potential claims issues using advanced analytics
- Ensure that your coding is very accurate
- Utilize technology to streamline the process
Embrace technology to make your billing and coding process effective and optimized for maximum revenue collection.
- Integrating Technology
Technology will streamline your entire process and make billing a dream. Saving time, decreasing errors, and increasing your revenue stream is the order of the day when you implement the right technology into your plastic surgery practice.
Effective and efficient coding and billing practices is only going to benefit your practice in the long run, and is vital to the sustained growth of your practice. So do not let the challenges of coding and billing get you down, rather leave it to the experts.