General Surgery Medical Coding Steps to Avoid Denials

Physicians in general surgery are facing an uphill task of medical billing keeping in check the different needs of the facilities and keeping a tab on the effective revenue cycle management to look for frequent denials and which of the claims need more efficient coding. The channel of insurance payment has been one of the most straining factors for general surgery physicians today affecting the bottom line of the revenue and in turn affecting the facility.  Individual physicians have a high cost of staffing and also revenue management which has led to many of them being absorbed by groups acquired by the hospital. General Surgery is one such facility that has seen a rise in individual costs and most of the facilities are either in the group or combined with hospitals. The field of general surgery covers a wide spectrum of diseases, operations, and procedures, which makes general surgery medical coding quite complex.

Tracking different types of patient care from appointment scheduling to registration and different steps for collection of the balance fall under revenue cycle management. The healthcare revenue cycle is a financial system that has brought in the work of administrative and clinical functions associated with billing. The process happens to take into consideration different data points which are coded into a format that helps the understanding of an insurance company. These codes are usually laid by the Center for Medicare and Medicaid Service (CMS) and also the price value of each procedure or diagnostic is decided beforehand to help cover the cost and also a margin of profit for the doctors.

There is also a growing concern among general surgery physicians which shift the value-based healthcare putting added pressure to improve the quality of the care, more risky management of care, and decrease reimbursement.  The facilities have to shift their business strategy towards creating new guidelines in the process of patient care and information gathering. Yet, this is certainly not a one-time event; progressing management and audit of the training’s budgetary tasks ought to be overseen reliably to decrease expenses and increment the revenue management to help develop the facility.

General Surgery Medical Coding Steps to Avoid Denials

Verification and Information

Many claim dissents are because of straightforward information section mistakes and they result in piling of errors with time. The inability to gather exact patient data and confirm the diagnoses and patient information about health from enrollment-related slip-ups can be costly. This regularly incorporates incorrectly spelled names, mistaken sexes, or potentially wrong insurance numbers along with incorrect information on patients’ earlier diagnoses. The patient’s record must be exact from the earliest starting point, and this establishes the framework for cases to be charged and handled. Having a claim kicked again from any payer because of patient socioeconomics is a superfluous refusal in the income cycle stream. Registration-related errors can be minimized, starting with front desk staff collecting accurate patient information during the scheduling of the appointment, at check-in, as well as check-out.

Coding Errors

ICD-10 diagnoses and Current Procedural Terminology (CPT) has laid down the coding guidelines and required inpatient medical record, coding errors have been one of the most important causes which have led to revenue losses and growth in denials from the insurance companies.  It happens that general surgeon physicians may skip the part that one diagnosis requires several of the procedures to conduct along with physicians’ time for the same. A small coding error can throw the bill off track and lead to a complete denial of the amount.

Get More Help for your General Surgery Medical Coding

General Surgery Medical Billing is one of the most complex billing management and this has resulted in billing mistakes running into millions of dollars. It might be time for you to switch to a outsource medical billing company that has a team of expert billers and coders to reduce your revenue cycle management workload. Contact Us at MBC to learn how we can help.