As physicians are considering the use of medical billing servers to stop the hemorrhaging of cash from their practices, they are faced with a broad range of options. On the small end of the spectrum are individuals working from their homes. On the opposite end of the spectrum are companies that employ hundreds of medical billers and have thousands of clients.



In thinking through the billing options available, it is crucial to understand that medical billing is complicated and requires deep expertise and broad experience. When a specialty is involved, such as surgical billing, the requirements for success become even harder to achieve. Success requires that the medical billing company have a team that is well versed with the complex rules utilized by insurance companies to adjudicate surgical medical claims.

With surgeons facing ever increasing costs they must insure that money is not being left on the table because they have a billing company that is not a surgical billing expert. Surgeons must also be aware that that many billing companies that claim surgery billing expertise actually outsource their surgery billing to work at home billers. Situations like this are fraught with the risk since the remote workers are not working in a controlled and monitored environment.

One of the major drawbacks of hiring a company that does not specialize in surgical billing is their lack of familiarity with the procedures and the terminologies used. Even if the medical billing company serves one or two surgeons, they will lack the depth and breadth of expertise required for successful surgery billing. Moreover if the hired company does not specialize in billing for surgeons, then they will not have the expertise to effectively appeal denied claims or answer questions raised by the insurance companies.

A typical sort-coming with medical billing services that do not specialize in surgery billing is the inability to properly track and pursue insurance underpayments. These underpayments cost most surgeons about 10% of their potential income. If a medical billing company does not understand the mult-procedure rules and have a system that can track underpayments (and does not flag every payment on a second procedure as underpaid), they will find it difficult to capture this lost revenue is a systematic manner.

These billing complications extend to the patient collections arena as well. The patient collection process for specialists like surgeons is more complicated because of the large patient balances often owed, the complexity of the procedures/EOBs that must be explained to patients that do not understand their bills and the older population surgeons often serve. A medical billing service with expertise in billing for surgeons knows how to deal with these situations. Billing services without such experience will increase the risk of both lower patient collections and upset patients confused about their bill.

To avoid all these billing related pitfalls surgeons need to utilize specialized surgery billing services. It is not advisable for an internist to perform surgery, similarly someone without training in surgical coding and surgical billing is not qualified to offer reliable billing services for surgeons.

Copyright 2008 by Carl Mays II