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How to Bring Down Insurance Claims Denial Rates for Plastic Surgery?

September 25, 2014

Plastic surgeons need a billing team with significant expertise and experience to get maximum payments from the insurance companies. Due to the tangled nature of plastic surgeries, surgeons have to face various reimbursement challenges. For instance, insurance only covers plastic surgeries done for genuine health issues. Surgeries done purely for cosmetic purposes are not covered under insurance.

This results in incorrect verification of insurance entitlement due to which the billing staff often ends up wasting time on submitting claims that are not eligible for insurance. This also causes them to oversee components of a plastic surgery that might be covered under insurance. If the billing staff is not experienced, both instances can disrupt the cash flow at a plastic surgeon’s clinic.

Most surgeries are listed under the “cosmetic” category by insurance companies, which do not come under the category of health related surgeries. Even if the billers present authentic information, insurance companies might deny the payment. For instance, bariatric plastic surgery after weight loss is performed for aesthetic as well as medical reasons. If the chosen plastic surgery doesn’t address health reasons, surgeons won’t get paid for the same.

How are Plastic Surgeons Bringing Down Claims Denials Rates?

It has been found that physicians without an experienced billing team can lose anywhere between 15-20% of their potential revenue. Considering the complexities involved in plastic surgery billing, surgeons cannot afford to leave payments uncollected by the billing department.

As the cost of surgery continues to increase, many plastic surgeons are finding it difficult to spend a considerable amount on billing technology and hiring, training and retaining skilled billers and coders. To ensure full payment, they are outsourcing their RCM needs to a medical billing company.

Companies like MedicalBillersandCoders.com have a strong team of experienced coders and billers who are familiar with the plastic surgery procedures. The team at MBC currently serves 42 specialties, including plastic surgery, helping surgeons collect timely payments and reduce the claims denials rates. Billing experts at MBC understand the multi-procedure rules involved in plastic surgery that helps them perform error-free claims submission, track insurance underpayments and appeal denied claims.

Benefits of Outsourcing Plastic Surgery Medical Billing

A reputed billing company will have the expertise to sail through billing challenges related to plastic surgery. It can help surgeons pursue insurance underpayments that can cost them approximately 10% of their potential income. With a clear understanding of plastic surgery billing needs, it becomes easy to track underpayments and get maximum reimbursement.

Billing companies can also help in the patient collections aspect because this process is quite complicated for plastic surgeons. The complexity of surgical procedures and large amounts owed as patient balances, make patient collections process difficult for plastic surgeons.

By outsourcing billing requirements to a third party, surgeons can eliminate the challenges of hiring, training and retaining skilled billing staff. They don’t have to invest in expensive billing software or worry about HIPAA compliance and other reforms during claims submission. Outsourcing is the safest way of getting paid for all the rendered services.


Category : Accounts Receivables / Claims Denials