Billing and Coding in a nutshell- The pictorial section will help you understand the 'this and that' of billing and management. Go through the infographs for an understanding of process, in short.
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.
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. 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.
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.
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.
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.