As anyone who has done surgical coding would vouch, it happens to be one of the trickiest medical subspecialties to code.\u00a0 Coding for minor procedure and endoscopies, coding for co-surgeons, appropriate usage of modifiers 54 and 55, pre and postoperative period coding, multiple surgery coding etc, all of these and more modifying circumstances would surely make any coder\u2019s head reel in horror.\u00a0 But the interesting fact is that despite these technical difficulties to surmount, the most significant factors for decreased surgical claims payouts are the following:<\/p>\n
3 Primary Causes for Reduced Surgical Procedure Reimbursements<\/b><\/span><\/p>\n 1. No Denial Management In Place:<\/span> <\/b><\/p>\n When compared to other specialities of coding and billing, denial management is all the more important in the case of surgical coding<\/span>, because the average number of surgical services offered by a surgery center is relatively less.<\/span>\u00a0 Thus every denial from the payor is a cause for concern.\u00a0 Even if the surgery center is capable of disputing denials and eventually getting the claims paid, unless a report is generated and studied about the patterns of the denial, reimbursements will always keep fluctuating.<\/p>\n A report has to be generated by the center classifying denials by surgeons, referring physicians, procedure type, payer etc, to finally arrive at the root cause of the denials and plug it.\u00a0 Even after you believe you have fixed the issue at your end and the denials continue, it would be a very good idea for your center to set up a face- to-face appointment with the insurance company.<\/p>\n 2.\u00a0 Dumping Everything on One Person and Not Outsourcing:<\/b><\/span><\/p>\n Typically surgery centers expect the front office personnel to also double up as the biller, coder, in fact as the complete revenue cycle expert.\u00a0 This is because the stream of patients in a surgery center is low compared to other healthcare centers and the powers-that-are decide that in order to cut costs, on the administrative front it has to be a one-man\/woman army.<\/span><\/p>\n Unfortunately this line of thinking ultimately backfires, since a person who performs so many tasks can never be expected to master even one, but then mastery of surgical coding is an absolute must for proper reimbursements from payers.\u00a0 Thus, the ideal solution in such circumstances is to at least outsource the coding portion to a dedicated medical coding vendor.<\/i><\/p>\n 3.\u00a0 Dictation Not Capturing All Coding Information<\/b><\/span><\/p>\n Accuracy of the dictation by the surgeon to a large extent determines how accurate the coder and biller<\/span>can bill for the procedure<\/span>. \u00a0\u00a0Unless the coder and the surgeon exhibit good camaraderie and complement each other, vital information may get left out in the claims sent to the payer, and invariably denial occur.<\/p>\n But as described above, rather than tackling denials in hindsight, if the coder and the surgeon have frequent tete-a-tete\u2019s to be on the same page, then denials, under-billing, and over-billing can be avoided<\/span>.\u00a0 This can happen only if a dedicated medical billing vendor <\/i>is employed, who would have no qualms in contacting surgeons any time of the day to clarify details before submitting claims<\/span>.<\/span><\/p>\n Thus, with proper attention to the above 3 circumstances the reimbursement pattern of a surgical center can be positively affected to increase overall revenues for the center.<\/p>\n","protected":false},"excerpt":{"rendered":" As anyone who has done surgical coding would vouch, it happens to be one of the trickiest medical subspecialties to code.\u00a0 Coding for minor procedure and endoscopies, coding for co-surgeons, appropriate usage of modifiers 54 and 55, pre and postoperative period coding, multiple surgery coding etc, all of these and more modifying circumstances would surely 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