Surgery Billing: Resources, News, & Insights on Best Practices

If you thought surgery was complicated, surgery billing can sometimes be a bigger pain. The processes can be tedious and elaborate. Every year, hospitals and surgeons perform a number of surgical procedures and file a claim for each surgery.

One of the foremost actions that can improve your familiarity with the surgery billing process is acquaintance with the physician’s manual. Usually, surgery medical billing rules are specified in the “Preamble” section of the manual. These rules include explanatory codes, health service codes and fees, in some cases details of specific cases (for instance if another surgeon assists with the surgery), as well as general information about the claims submission process.

surgery medical billing

Surgery Billing Claims Submissions: Timing Is Everything

One of the most integral aspects of the claims submission process is the timing. These are often different for different departments, medical consortiums, districts, provinces and countries. However, the surgeon or biller should have clear records of surgery and be mindful of the timing of the claims. Usually, there is a period of 90 days to submit claims, from the date of the surgery.

surgery billing claimsExceptions beyond that are allowed but only in extraordinary circumstances. Reversals of claims in case of accident or other circumstances can also be submitted, as long as original claims are still available. It is imperative that a surgeon’s office maintain proper surgery billing records of all surgeries and file them appropriately.

In terms of methodology in this area of surgery billing, most submissions can now be made electronically for Fee for Service (FFS) and Shadow claims. However, to expedite the process and avoid conflicts with the department designated for approval, it is important that these comply with the guidance of the physician’s manual. There are many benefits of timely and accurate billing:

  • Reduces the possibility of the claim being rejected
  • Reduces the possibility of poor audit results
  • Helps to maximize surgery billing
  • Helps to capture benefit of services eligible for incentives.

Common Surgery Billing Errors

Some of the more common surgery billing errors include a lack of documentation, citing a visit when the encounter between surgeon and patient was in fact the procedure, and citing a full visit for a non-complex problem. It is imperative that surgeons try to avoid these since it needlessly tarnishes the reputation of the surgeon and the institution sometimes.

It makes sense for surgeons and physicians to hire or request extra help for these purposes of complex surgery billing. A proper filing system should be put in place and this can often be achieve by working with an experienced medical billing firm adept in surgery billing procedures. Additionally surgeons should establish clear channels of communication and review the claims before they are filed. Since there are different billing rates and percentages for single procedures, multiple procedures and bilateral procedures, there is always room for confusion.

Surgery Billing Software

There are different software available for surgery medical billing. These can serve as good alternates to manually filling out claims, and reduce the risk of error. As a final note, here are some tips and strategies for better surgery billing:

1. Organize your paperwork: A simple but essential step.

2. Document visits and procedures scrupulously.

3. Understand insurance coverage: if you don’t know what insurance covers or does not cover, your job will be more difficult.

4. Don’t let denials get to you: often it is a frustrating and complex process, but there are appeals and coverage in place to protect your claims as long as they are valid.

5. Use all available resources, be it software or an external agency.

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