Reconstructive plastic surgeons require an expert medical billing team that can help them get maximum reimbursement from payers. Plastic surgery is one of the most challenging medical specialties. Obtaining timely payments and maximum coverage from insurance companies can be a daunting task if surgeons don’t have an efficient billing team.
When it comes to a patient’s personalized authorization and billing needs, reconstructive plastic surgery billing can become more complicated. Considering the complexities of the surgery procedures, surgeons face various revenue challenges.
Revenue Challenges for Reconstructive Plastic Surgery
If plastic surgery is performed purely for cosmetic purposes and not for genuine health issues, it will not get covered under any insurance. Such surgical procedures lead to incorrect verification of insurance entitlement and billers end up wasting time on submitting claims that are not eligible for insurance. Insurance companies list majority of the plastic surgeries under “cosmetic” category.
Since these surgeries don’t come under the “health-related surgery” category, insurance companies deny payment even if billers present authentic information. In such cases even if certain components of the procedure can get covered under insurance, they are not reimbursed by the billers. This is one of the main reasons why billers and coders need to be certified and experienced to identify any loopholes and ensure maximum payment.
- 15 – 20% of the potential revenue is lost if a physician doesn’t have an experienced billing team. Due to the billing complexities involved, plastic surgeons cannot afford to leave uncollected payment on the table.
Surgeons also need professional medical billing tools such as a revenue cycle management (RCM) system specifically meant for plastic surgery and which can easily handle charge entry, automate submissions of medical claims and maximize collections through an easy-to-use interface.
Is Outsourcing an Effective Solution for Revenue Challenges?
With the increase in cost of the surgeries, it is becoming difficult to spend a large amount on hiring certified billers and coders and maintaining the latest billing software. Many providers are reluctant to spend the required amount on training the existing billing team for coding changes such as ICD-10. This is one of the major reasons why a growing number of plastic surgeons in states like Chicago, Florida, New York, etc. are outsourcing their RCM needs.
Many reconstructive plastic surgeons in the States have started outsourcing plastic surgery medical billing in Chicago, IL to a third party. They are partnering with experienced and professional billing companies such as MedicalBillersandCoders.com to enhance the profitability of their practice. Companies like MBC have a team of certified billers and coders who have thorough knowledge of clinical pathology, anatomy and the patient advocacy required for plastic surgery billing.
From procuring maximum reimbursements from payers to obtaining authorizations from insurance companies, outsourcing plastic surgery medical billing services in Chicago, IL has given various benefits to surgeons. Reputed companies make use of the latest IT tools and billing strategies to help surgeons boost their income. Since a daunting yet vital task like billing is handled by an expert team in outsourcing medical billing, reconstructive plastic surgeons can use the free time to improve their plastic surgery practice.