Computers, software and automation have simplified the way industries perform their otherwise complicated and utterly chaotic business operations. This automation has been extended beyond the technological and manufacturing fields into medical practices. Medical professionals, like doctors and surgeons, are technically adept in their respective fields, but they often lack the knowledge or expertise– not to mention the time or the personnel– to manage their cash flow systems as efficiently and as accurately as they would prefer it to be. What they need is an efficient and automated surgical billing service that will help them run their practice more efficiently.

The healthcare system’s environment is constantly evolving, leaving modern practitioners unequipped with the proper systems and resources. This is especially true in the complex arena of medical billing, and thus practices should hire people or service providers that have experienced-based expertise in dealing with insurance companies. These professionals should also be well-trained in the specific codes, rules and regulations of surgical and medical billing. Using these services can reduce the errors in their billing department, which in turn can cut significant financial losses that could amount to more than 20 percent of revenues from their clients’ practice.

This article on surgical billing aims to help surgeons and medical professionals understand all the important aspects of the field and select the most appropriate billing service for their practice.

What Is Surgical Billing and What are the Processes Involved?

Insurance companies have their own computerized systems and billing software that process medical claims and records from various patients, medical institutions and healthcare providers. These providers should ensure that they give the correct information and paperwork to the insurance companies; otherwise, their claims will be rejected and payment will remain unauthorized. Imagine doing all this paperwork manually, and then individually sending each claim to the insurance companies. That would be a very taxing and tedious process that takes a very long time to reach a conclusive end.

Surgical billing services are designed to solve these issues. In -house billing and coding specialists can be hired to handle all patient records including treatment information, insurance details and bills. The services also include encoding of the patient’s diagnosis and procedures. A request for payment is later sent to the patient’s insurance company or directly to the patient on non-insurance cases. These billing services can also be outsourced to service companies staffed with skilled medical billing and coding specialists using customized billing software, which transcribes all these records in standardized codes and formats as required and accepted by the insurance companies. They can also communicate directly to the patients regarding their billing statement and discuss what payment options would be used in the process.

An intrinsic part of this process is the proper organization of patient’s records, which ensures that error-free information is used for the coding process. During coding, the information related to disease, diagnosis and treatments as recorded by the surgeons are matched with the insurance policy information. The patient can then determine areas that are covered and those requiring additional payments.

Benefits you can get from outsourcing surgical billing services.

  • Surgeons and their staff are spared from the time-consuming complexities, frustrations and the headaches that go with managing surgical billing process. They can devote more attention on providing excellent healthcare and services to their patients.
  • Surgeons, clinics and medical facilities can save much on overhead costs by utilizing the services of surgical billing companies. Practices can forego hiring fulltime medical billing and coding staff to handle tasks such as transcription of medical records, billing processing, invoicing patients and filing insurance claims. They can save on salaries, taxes and benefits, which are basic requirements for fulltime staff. What’s more, practices can also save on operational expenses spent on maintaining billing office- papers, office equipment and other supplies.
  • Outsourcing billing services can also save practices the costs of providing specialized training to personnel that will handle medical billing and coding functions. Billing service companies make sure that their staffs are competent and fully trained in the billing and collection function. Their trained staff can easily handle billing issues like delinquent accounts, complaints and claims rejection.
  • Surgical billing services can also help spot underpayment of claims by insurance payers by looking into latest trends in the payment patterns and comparing them to practices’ contracted rates. Usually underpayments range between 5 to 10 percent, which would add up quite significantly and would be considered revenue loss on the part of the surgeon or the medical institution.

Practical Tips on Choosing the Best Surgical Billing Services

The following are some tips which can be helpful while searching for the most appropriate billing and coding services.

  • There are different surgical disciplines and specialties in the field of medicine, and it is thus advised to choose a surgical billing service that offers experienced-based expertise for your specific surgical field. One should remember that each specialty has its own corresponding insurance policies and regulations that cover procedures in making claims and payments.
  • If the billing service company claims they can provide services for your particular field, they should also be well-informed and updated on the constantly changing regulations in making claims. They should also have highly trained staff certified in the proper coding for claims submissions.
  • It has to be noted that Medicare has deemed illegal some practices or requirements made by some surgical billing services that insurance payments be deposited in their own account. Payments should be made to your account and you should never allow any services to control your cash flow or income.
  • Find a surgical billing service that waives or does not require a setup or startup fee. If your billing service is insisting that you pay such fees, move on and look for another billing company
  • The advances in communication have allowed billing services to operate from any state, allowing you to employ good companies located nationwide. This would allow you to choose more competent institutions to render these services. However, make sure that the companies are well familiar with the insurance companies and state regulations operating in your area.
  • The surgical billing and coding company you are considering should use modern equipment for electronic processing, including submission of claims to insurance companies. This allows for faster processing and shorter lead times in receiving reimbursement checks.
  • Gather statistics from sources regarding the billing service companies you are considering, including claim denial rates, length of service rendered for other medical institutions or professionals, and their turnaround time in obtaining payment for claims. The billing service company should also be compliant with HIPAA regulations.
  • The surgical billing service company should have an internal tracking and report system to keep you abreast of your claims and help you manage your accounts on a monthly basis.

The surgical field is a complex and challenging area of medicine, and this complexity is translated even to billing services and submitting insurance claims. Surgeons need all the help they can get to avoid wasting precious time in administrative work. They can be assisted by surgical billing services that help them receive proper compensation and deliver higher quality healthcare.