Plastic surgery Medical billing:
Plastic surgery billing is complex and requires both broad and deep expertise in the field in order to properly code, bill claims and to handle the follow-up process. To appeal claims and answer questions from payers especially, your billing team should be knowledgeable about plastic surgery procedure and terminology.
The major challenge to plastic surgery medical billing is the difference between essential plastic surgery and cosmetic surgery. Cosmetic surgical procedures may not be covered by most insurance companies. So, if your claims do not clarify that a surgical procedure was performed for the patient’s health related issues, or for reconstructive purposes, they may be denied. Outsource Strategies International (OSI) understands the intricacies involved in billing for this specialty and offers professional support that will ensure you gain maximum reimbursement. Our plastic surgery billing services are reliable, affordable, and HIPAA-compliant.
Common Plastic surgery billing issues:
Lost and incorrect documents, mistakes in coding and disorganization can all contribute to the need to refile, if not a substantial revenue loss. In fact, inadequate coding and billing expertise is estimated to end in the loss of up to 20% of potential repayment. Thousands of dollars are lost each year this way. Many practices have opted to hire an experienced third-party team to reduce time, stress and lost funding. The fee associated with hiring outside of your practice is far less than the reimbursement you would otherwise lose, thus resulting in an influx in revenue overall
Although a type of plastic surgery, it is for the most part a complex reconstructive or health-related procedure, where, if the attendant health risks are not adequately addressed, the patient would go through long suffering and be faced with serious health hazards. This being the nature of the surgery, it often presents the physician with the challenge of separating the parts of the procedure that are covered by Medicaid and the parts that aren’t. Our medical billers are coders are adept in handling these complexities and helping you prepare an air-tight claim with minimal chances of denial. The common denials occur in Breast Reconstruction, Palatoplasty, Blepharoplasty, Rhinoplasty (nose job).
Health Insurance Companies May Evaluate What Is Covered for Plastic Surgery Differently
Insurance companies are the interpreters of the above definitions. One example of how different insurance companies may look at things differently can be found in the procedure of circumcision on infant boys: In the past insurance companies paid for this procedure, but it is now becoming more common that insurance companies will not pay for the procedure because it is considered cosmetic.