Although plastic surgery is generally indentified as a looks enhancement medical procedure, in many cases it’s done to address genuine health concerns. And often a singular treatment episode may include both: measures to address health concerns (reconstruction) and improve looks (cosmetic).
This tangled nature of plastic surgeries often presents a considerable challenge to patients and surgeons as surgeries done purely for cosmetic purposes are not covered under insurance while the ones performed to address genuine health issues are.
This leads to incorrect verification of insurance entitlement often leading to time spent on preparing claims for surgeries that don’t enjoy insurance eligibility or oversight of components of a surgical treatment that come under insurance coverage. Both instances affect the revenues of the plastic surgeon or the clinic of which he/she is a part.
Our medical billing services in Florida can help you to increase your revenue with the reduction in the number of denied and unpaid claims. Our billers present in all the major cities like Jacksonville, Miami, Tampa, St. Petersberg and Orlando can provide you with less paperwork and more accurate medical claims to improve the efficiency of your practice. Here are some of the services which our billers have shown their proficiency in:
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Claims are processed on the same day
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Analysis of accounts receivables
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Weekly as well as monthly reports on productivity
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Analysis of codes and procedures on a regular basis
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Review of fee schedules for updates
Comprehensive Medical Billing Services in Florida
As a Leading Medical Billing and Coding Service provider, we offer specialized medical billing services in Florida to optimize your revenue and reduce denied claims. We have a strong presence in major cities like Jacksonville, Miami, Tampa, St. Petersburg, and Orlando. Our billers and coders are experts in streamlining workflows and ensuring accurate claims submission.
They have over two decades of expertise in:
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Same-day claims processing to expedite payments.
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Detailed accounts receivables analysis to minimize A/R days
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Weekly and monthly productivity reports
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Regular code audits to maximize reimbursements
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Updating fee schedules for compliance and accuracy
Florida Medical Billing Experts Maximizing Your Practice Revenue
Our Florida-based professionals understand the state’s unique healthcare dynamics, including its extensive Medicaid Institutional Care Program (ICP) and high elderly population. By navigating state reimbursement statutes effectively, our coding specialists ensure compliance and better cash flow for your practice.
MBC’s medical billing experts in Florida offer tailored solutions:
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HIPAA-compliant processes to safeguard patient data
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Credentialing services to streamline payer enrolment
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Handling complex specialties like Cardiology, OB-GYN, Pediatrics, and more
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Expertise in EMRs and top billing software, including Medisoft, eClinicalWorks, and GE Centricity
Against Florida’s ongoing physician shortage, we help reduce administrative burdens while ensuring steady growth and profitability. By utilizing EMRs and advanced practice management systems, a Revenue Cycle Management Company optimizes operations and boosts collections significantly.
Our medical billers in Florida have been tracking the rate of reimbursements, which has been dipping in the state over the past decade. They have also analyzed the solution to this dip; the answer lies in the state of Florida’s reimbursement statutes themselves. These local Florida billers are the key to unlocking blocked cash flows and can provide you with updated methods to improve the efficiency of your practice.
Value Our Florida Billers Bring:
Our medical billing and coding services in Florida are not limited to major cities such as Jacksonville, Miami, Tampa, St. Petersburg, and Orlando. They also extend to almost all other towns and smaller cities in Florida. These medical coders and billers surpass HIPAA compliance and are trained in preferred languages such as Spanish. They have been recommended in their past engagements for their medical billing administrative skills, excellent Data Entry management, and good written and oral communication skills.
Our medical billers and coders in Florida perform specialized tasks such as reviewing encounter forms for accuracy in ICD-10 and CPT coding, maintain records of existing billing and coverage rules, posting charges and payments to accounts, make follow up calls to insurance companies to resolve any inconsistency in payments and to patients whose accounts were past due to set up a payment plan, report to physicians regularly, offer customer support by comprehending and elucidating insurance EOBs, co-pays, co-insurance and deductibles to patients and enter and revise patient demographics.
Our Specialties:
Our medical billing specialists in Florida can help increase your income and guarantee suitable reimbursement. They provide medical billing and coding services in specialties including Otolaryngology, Primary Care, Optometry, Family Practice, Hospitalist Billing, Cardiology, OB-Gyn, Physical Therapy, Paediatrics, Internal Medicine, and Dental.
Our Software Experience:
Physician shortage will always be a problem in Florida, affecting doctors and more prominent hospitals, hospices, nursing homes, nurses, and resident doctors. The shortage would mean long working hours and more accurate medical coding and billing practices. However, implementing EMRs is proving to be of immense help since most of the paperwork is diminished, and doctors have real-time information about patients and other related data. Our coders and billers are experts in software such as Medisoft, Misys Tiger, eClinicalWorks, Advance MD, GE Centricity, and Altapoint.
Difficulties & Challenges Florida Physicians Face:
One of the unique challenges that physicians and healthcare providers in Florida deal with is the Florida Medicaid Institutional Care Program (ICP). This is because Florida has a large elderly population (65 years and older), which is projected to grow to nearly 26% of the state’s total population, the highest among all states in the US.
These elderly patients are either disabled or fighting chronic illnesses, making them frequent visitors to physicians’ offices and various hospitals. This fact, coupled with the recent healthcare reform, would ensure that health care providers are required to ensure accuracy and compliance with legal guidelines to avoid a drop in revenue or negative legal repercussions. Our medical billing specialists ensure that problems such as inadequate reimbursement due to claim denial and other related factors do not take their toll on your practice.
Our Medical Billers and Coders can improve your practice's efficiency by employing the best methods of optimally using your EMR. Their exposure to various Practice Management Systems also provides greater collections for your practice.
Outsourcing to MBC:
MBC’s medical billing and coding services cover the entire range of insurance-claim-related requirements for plastic surgery, starting from eligibility verification of the patient to claim submission and post submission follow-ups.
Plastic surgery practices lose significant revenue through misclassified reconstructive claims denied as cosmetic, undercoded tissue flap and wound repair complexity, and multi-procedure operative sessions reduced by incorrect modifier application that payers exploit without pushback.
MBC's Revenue Diagnostic evaluates your plastic surgery billing at the procedure, payer, and operative session level — identifying where reconstructive complexity is being downcoded, which skin substitute and post-mastectomy reconstruction claims are failing adjudication and why, and how your AR aging compares against specialty benchmarks. The output is a clear, actionable breakdown of the revenue your practice is currently leaving uncollected.
With years of experience in dealing with plastic surgery cases in particular and insurance claim preparation and submission in general, our medical billers and coders understand the nature of your organization, its size and scale and bring to you an approach that’s customized to your specific needs.
It helps you meet your administrative and technical responsibilities involved in claim preparation and submission and improve your finances.
MBC delivers this both through a consulting model where it helps you to streamline your revenue management cycle by recommending appropriate software applications, helping plug sources of revenue leakages and trainings where required, and also outsource your entire billing and coding responsibilities to MBC.
Plastic surgery billing operates at one of the most complex reimbursement boundaries in healthcare — where revenue depends on the precise segregation of reconstructive and cosmetic services, accurate documentation of medical necessity for insurance-covered procedures, and the correct application of modifiers across multi-procedure operative sessions that payers challenge routinely.
MBC acts as your Revenue Integrity Partner by ensuring that every plastic surgery encounter is coded to its highest defensible specificity, reconstructive vs. cosmetic service boundaries are correctly maintained at the claim level, and payer policies around skin substitute applications, tissue flap complexity, and post-mastectomy reconstruction sequencing are executed with precision — so your practice retains every dollar it clinically justifies.
Some of the popular procedures that our billers and coders recommend could be problem areas in your revenue leakage:
Breast Reconstruction :
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.
Palatoplasty :
A surgery to repair cleft palate, this procedure involves parts that are not purely cosmetic but reconstructive presenting the challenge to physicians or clinicians to identify such parts of the procedure as would be eligible for insurance reimbursement.
Our medical billers are coders are skilled in helping you conclusively separate the parts of the procedure that have reconstructive character and therefore insurance eligibility from parts that don’t.
Blepharoplasty :
A procedure to correct hooded eyelids, even though it’s cosmetic in nature, it is a surgical correction of a defect with the potential to damage a body part – the eye – and therefore reconstructive in parts at least.
We help you identify the reconstructive areas of the procedure to ensure you are reimbursed for them.
Rhinoplasty (nose job):
It involves correction of a part of the nose that, if not properly aligned, can affect the functioning of the nose. However, as Rhinoplasty is broadly cosmetic in nature, physicians often overlook this reconstructive element which is eligible for reimbursement.
MBC’s billing and coding professionals have helped health care providers involved in plastic surgery bring down their insurance denial rates substantially leading to timely payment of their services and optimal use of their staff either by helping them to focus solely on healthcare or by providing consultancy services so that they handle their revenue management responsibilities more effectively with the help of appropriate software applications and smoother and easy-to-follow processes.
MBC will help you perform the perfect plastic surgery by taking over what MBC does best so that you have to only do what you do best – surgery.
Plastic surgery is a procedure-intensive, documentation-driven specialty where revenue leakage accumulates through reconstructive-cosmetic misclassification, missed add-on codes across complex wound repair and flap procedures, and medical necessity documentation gaps that give payers grounds for denial without internal detection.
MBC helps plastic surgery practices Yield your EBITDA by maximizing reimbursement on high-complexity reconstructive procedures and multi-stage operative sessions, reducing denials on tissue flap, skin substitute, and post-mastectomy reconstruction claims, and ensuring that every billable service performed — from complex wound closures to microsurgical reconstructions — is captured, coded, and collected in full. The result is a billing operation that turns your surgical complexity directly into sustainable financial performance.
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