Surgery billing simply refers to the process through which surgeons and related medical providers submit and consequently follow up on all claims with the respective insurance companies. This is usually done in order to allow surgeons to receive full payment for the services which they have already provided. The entire surgery billing process usually takes several days sometimes even a few months depending on how busy the healthcare provider was during the specified period.
Usually what happens when a patient goes to a healthcare provider is that any tests or better yet procedures which are done are all properly documented by the attending physician. What follows is the medical coder determining the exact diagnosis codes after which the surgery biller transmits these codes to the health insurance company in order to allow for the subsequent processing of payment by the respective insurance company for the services.
Sometimes a submitted claim can be rejected. In such cases, the surgery biller is forced to carefully review and then resubmit the claim. If this does not work, the healthcare provider will have to accept an incomplete reimbursement. After this negotiations can be initiated between the insurance company and the healthcare provider in order to allow for payment in full.
An Overview of What to Expect From Hiring an Expert Surgery Biller
A surgery biller is responsible for compiling and submitting all claims to the insurance company in order to allow for the processing and subsequent payment of services which may have already been rendered.
Usually the insurance companies in question also counter checks the healthcare provider claim submissions consequently either requesting for a resubmission of approving all payments in case everything checks out. In the event that there is any outstanding balance then it is the surgery biller who arranges and sends the disputed bill to the patient.
When investing in surgery billing services or related medical billing solutions, make sure that this individual or company has specific expertise in the type of billing that your practice conducts. In addition to that below is an overview of what to expect from hiring an expert surgery biller.
- Verification of all the patients insurance coverage
- Handling of collections as well as all unpaid accounts. This the surgery biller will does by establishing arrangement of payments with the respective patients. In addition to this, in the course of the surgery billing process expect the surgery biller to help in closely monitoring payments as well as following up with patients in case there is any disputed payment.
- Coordinating with the insurance company and the health facility in a bid to make sure that all the claims are all successfully processed and payment is ultimately approved.
- Management of all the accounts receivable of the facility and carefully reviewing any denied or unpaid claims
- Coordinating with the medical coder to use the coded data provider to produce and the finally resubmit claims to the respective insurance company for review and consequent approval of payment.
- Answering and advising of patients on any queries which they be having about their surgery billings
- Management of all the bill queues on a regular basis
- Proper understanding of the insurance guidelines particularly the Medicaid and Medicare
- Submission of all secondary billings in a timely manner alongside all supporting documentation.
Simply put, hiring an expert surgery biller serves as a guarantee for work with someone who is great at time management and clearly understands his responsibilities to the health facility as far as management and processing of payment is concerned. Being an Expert, expect the surgery biller to be able to work closely with the rest of the staff at the health facility in identifying, sharing information and most importantly resolving any issues patient billing.