With the increased focus on health care in the United States and the increasing need for specialized medical services, especially for surgery, it is important for surgeons and healthcare professionals to better optimize their billing practices. By establishing a systematic and dependable surgery billing system, the outcome can be mutually beneficial for both staff and patients.
To optimize your surgery practice’s billing system, below we offer five tips toward better surgery billing, faster payments, and greater financial health.
Effective Tips for Surgery Billing
1. Effectively manage lag and turnaround time. One to the easiest ways to decrease outstanding billing days is to manage lag times. Lag times should number less than five days – the fewer days, the smoother the system will become. Various surgery centers may suffer long lags due to circumstances beyond their control. In such cases they should demand a 24 hour turnaround. These can be enforced with penalties and if not it may be time to search for other companies to fill the void.
2. Learn and understand the electronic pathway. To establish a surgery center billing system, it is important to chart an electronic path for each patient. Since electronic claims are sent to health providers directly to the provider’s EDI company and several other business partners lag times can be exceptionally long.
This can be prevented or lessened if the electronic path is defined and closely monitored on a transaction by transaction basis. Billing managers should start to chart these points to determine if a claim goes directly to the payor or to an additional clearing house or center before reaching its final destination. If issues arise in the process it is wise to call and ask if they have a direct contract with the payor.
3. Insurance verification. It goes without saying that much time is wasted without verification. It is vital to make sure the patient has coverage before undergoing any procedure. It is also wise to confirm the deductible to learn if the patient has a “trash plan” – a very low premium and extremely high deductible.
Additionally many good centers are now verifying benefits of outpatient vs inpatient coverage because there is a difference in many policies. Naturally verifying insurance requires a phone call and that phone call takes time but during this conversation the carrier can advise as to the best procedure for submitting the claim. There are many plans where coverage may change. Carpal tunnel doesn’t require authorization today but this may change without knowing about it so it is always good to verify.
4. Codes must be in correct order. Put codes in the right order so as not to lose reimbursement. For example, Medicare reduces any procedure listed second by 50%. If a $1,000 procedure is listed first and another listed second at $750 this will ensure that you will take the cut on the $750 and not the larger one. It is vital to do this correctly in the first place because by trying to fix it will take more time and of course increase lag time.
5. Managed care. Being aware of every aspect of surgery billing is essential. Surgery billers should have a copy of every managed care contract and understand the details. Details such as how long you have to submit a claim, how long the adjudicated process is, what payment methodology is and why an carrier would reduce multiple claims and what the appeal process is all about are all issues that are vital to learn, understand and put into practice.
Many of these non-human issues can be corrected and or eliminated by installing proper software. The money and times saved will far outweigh the cost of the software.