The Impact of Effective Billing and Coding in General Surgery

According to experts, billing and coding are two of the most common areas of improvement for any general surgery practice. A surgical practice could be capable of offering exceptional service to patients. However, if the backend process doesn’t support the surgeons, the practice wouldn’t be able to survive for long.

As a surgeon, your days must be busy and hectic, and treating patients must and should be your priority. However, when you run a practice, apart from being a doctor, you are also forced to be a business professional, worrying about expenses, profits, and business stability. This may get too much for the surgeons and is primarily the reason for physician burnout, a critical component that may prevent patients from accessing the right healthcare services.

Medical billing and coding companies are often hired as third-party service providers to help outsource the backend billing and coding processes. These are the biggest and most significant administrative tasks that suck the time and resources in any general surgery practice.

How do effective medical billing and coding help general surgery practices?

1. Expeditious workflow
One of the biggest strengths that third-party medical billing and coding companies can bring to large practices is speed. Let’s say you work in a busy surgical practice that sees hundreds of patients weekly. These could include scheduled patients, emergency visits, and out-patients too.
Your billing and coding team needs to sync with patient volume and make sure bills are submitted on time and reimbursements are claimed in the same A/R cycle. Delays can create instability in financial operations.

Using our AI-based tools and expert coders, Quintessence can help a bill move from encounter to claim in less than 24 hours!

2. Reduced denials rate
When do claims get denied? While there can be several reasons for it, in the backend, there are some common reasons.
• Wrong/incorrect documentation
• Capturing the wrong services rendered for the mentioned health condition
• Missing code modifiers
• Missing/wrong codes

Documentation plays a vital role in reducing denials and improving collections as inaccurate coding is based on unclear documentation.
Example 1 – Size is important in the excision and repair procedures, if no size is documented coders have the liberty to consider it as a minimal size. When an umbilical hernia is performed, if the size of the hernia is not documented coders will have to code for less than 3cms i.e 49591 (Repair of anterior abdominal hernia(s)) the difference between the billable value of 49591 & 49593 (Repair of anterior abdominal hernia(s) for 3cms – 10 cms) is over $150.00.

Example 2 – While performing Ultrasound guidance for access if the patency of the vessels is not documented coders cannot bill for Ultrasound (76937 – Ultrasonic Guidance Procedures for vascular access)

That’s why hiring experienced third-party medical billing and coding companies like Quintessence who can guide through Clinical Documentation Improvement and bring a difference from day one.

3. Impactful and precise coding practices
Coding errors are widespread in surgical practice because of the sheer complexity of the services offered. There are thousands of codes and modifiers, and combinations that could be used for different services provided in surgical practices. The following are some of the specific coding problems encountered by surgical coders.

• Missing codes when multiple procedures are performed
• Encountering unbundled procedures
• Codes that don’t emphasize the medical necessity
• Incorrect mention of reporting units

When such problems occur, three things can happen.
1. The codes don’t match the service rendered, and the claim is denied/rejected.
2. The codes don’t capture the entire expanse of services rendered, leading to partial reimbursements.
3. The codes are wrong/incorrect, leading to denials.

Let’s understand this with 2 examples. In surgical practices, Medicare has different rates for unilateral and bilateral services. Logically, bilateral services have a higher base rate than unilateral services. The -50 modifier needs to be used if bilateral service is offered.

Example 2 – Documentation of time duration for certain procedures is important, the clinical report might just say moderate sedation without the time being documented, in such scenarios coders code it as a single unit of 99152 (Under Moderate Sedation for initial 15 minutes of intraservice time)

If your coder doesn’t realize this and does not code correctly, claims would still be processed and paid for, but you would receive lower reimbursements because you are paid for lesser units of service. Over time, this can pile up and cause a considerable dent in your finances.

Precise coding will help bills move quickly toward reimbursements. It is costly to appeal a claim after it is rejected. That is why it is preferred that the coders get the codes right the first time around.

4. The use of intelligent technology betters your existing processes
Another reason why medical billing and coding companies and their billing and coding processes may benefit you is the technology they use. Service providers invest extensively in their tech resources because that’s their competitive strength. A healthcare practice, despite its size, cannot justify the investment just for billing and coding.

So effective billing and coding that is backed by the right technology can be your best bet. Such technological boosts can help intelligently automate many of your existing RCM processes and bring them precision, speed, and reliability.

5. Help practices focus on their strengths
As a surgery practice, your main focus is the medical care you provide patients. When billing and coding are effective and taken care of by reliable medical billing and coding companies, it leaves you with enough time to focus on and grow your core strength.

6. Increased revenues
Medical billing and coding are aimed at sending bills to the payers (insurance companies, in most cases) and collecting revenues. When the billing and coding process is done right, your bills get passed through, and payments are collected on time.

Billing and coding are just parts of the Revenue Cycle Management operations. Medical billing and coding companies take care of other steps, including eligibility verification, documentation, payment posting, AR follow-up, and even analytics and business intelligence.

All these processes are also aimed at helping build seamless and precise claims that can be fully reimbursed without complications. When you work with a brand like Quintessence, you can be sure that we do everything possible to streamline your RCM operations, and this will increase your revenues by itself without you having to make extra efforts.

Medical billing and coding practices are integral for healthy RCM operations. For general surgery practices, imperfect or inaccurate billing and coding can lead to administrative complexities that add to financial and legal burdens.

You can wade through these complexities by hiring medical billing and coding companies like Quintessence. We have a combined 100+ years of expert work experience, and our tools and technology are some of the best in the industry. We know the nuances of RCM services and maintain a great rapport with all payers, clients, and industry leaders.

With Quintessence as your partner, you can be assured that your billing and coding processes support your growth, instead of holding you back.

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