How Could Alternative Billing Help General Surgery Billing?

“General Surgery” is a discipline of surgery having a central core of knowledge embracing anatomy, physiology, metabolism, immunology, nutrition, pathology, wound healing, shock and resuscitation, intensive care, and neoplasia, which are common to all surgical specialties. Due to the numerous illnesses looked after by a general surgeon, the billing and coding (for surgical sub-specialties too) often come with numerous challenges as well. The complexities of coding, procedure rules manifold and complex contractual adjustments are required to be addressed with care and expertise for apt and timely reimbursements. The complexities include being knowledgeable about the latest rules such as moderate sedation being separately billable, addition of new mammography codes, new coding for endovascular ablation and endovascular revascularization, under Hemodialysis access – coding for angioplasty and stent placement, thrombolysis or Thrombectomy, new option for GERD – esophageal sphincter procedure, appropriate coding for fluoroscopic guidance, additions of codes such as 22853, 22854, 22859, revisions of codes 19298, 28289, 31576, along with deletions of codes such as 11752, 22851, 28290, and additional tips for distinguishing between modifier choices along with documentation tips to support billing etc.

But with increasing copays and insurance premiums, it is getting increasingly difficult for Americans to pay the high cost of healthcare. According to Christy Ford Chapin, author of Ensuring America’s Health: The Public Creation of the Corporate Health Care System, “It was way back in 1938, that structural problems with US healthcare began.” With new diseases and vaccines, hospitals became a safe haven to get treated in. Though free care and the barter system were available at that time with clinics, people began to feel that it would be beneficial to pay small amounts regularly than wait for an emergency to occur and pay all at once (insurance works by the same logic today). Finally, due to the Great Depression, etc., TIME in 1938 reported that “Hard times for doctors and patients [and] changing social attitudes have caused doctors to consider new ways of distributing medical care.” Initially, insurance barely covered anything. However, slowly, with time, as it became more widespread, it seemed to be the obvious choice for most Americans. And according to Chapin, “the model of multi-specialty group practices with flat fees would likely have prevailed if the American health care market had been allowed to develop on its own without that 1938 decision.” And today, insurance has expanded politically, while proving that privatization is possible in healthcare, escalating costs and becoming unaffordable for many Americans.

Alternative / Remedial Strategies For General Surgery:

But, a handful of doctors in Idaho are again going back to alternative models for those who do not have/can not afford any kind of health insurance.

  • An alternative payment system called ‘Direct Primary Care’ has been devised by Dr. Flint Packer. According to him, in this model, the doctor directly bills the patient. A monthly fee is paid by the patient (initially $100), till the patient or the family member ($50) hits the limit of $300. Once this cap is reached, anyone in the family can go for checkups to the doctor without having to pay anything extra. Though he does recommend patients getting catastrophic insurance with high deductibles and low monthly payments.
  • Dr. Jim Brook has devised another alternative model. He charges by the minute (5 min is $19 while 60 min is $167, all paid in cash). This model has seen utmost success with Dr. Brook having to turn away patients due to being over busy.
  • Another plan is the Christian Healthcare Sharing Plans where a group of people pools in money to pay for an individual. Every month, this individual and the rest chip in their share for another individual who might need that money to pay his hospital bills.

In conclusion, these alternative models could be used by expensive specialists and general surgeons too. And as general surgery billing and coding is extremely tough and time taking, these alternative approaches/models could pave the way for solving many issues of the overall expensive healthcare programs while focusing more on patient care.