As a Surgery Practice, you have unique billing issues, whether it is surgical bundling rules or understanding how to code a decision for surgery.
At Strategic Solutions, we monitor changes in each specialty area that result from CPT-4 changes, new coding edits, or even areas of focus from the Office of the Inspector General.
We communicate with you through our one-on-one meetings or through Billing Alerts to ensure you understand the ever-changing payer rules.
Surgery is one of the more complex billing areas and has been faced with several challenges over the last few years:
- Variations among payers on how and when to use modifiers. We know what each major insurance company expects and work with you to get the right information to payers, so your claims get paid correctly the first time.
- Thorough denial review process. At times, an insurance company's internal edits result in an inappropriate denial. All denials are reviewed by our certified coders and appealed when needed. Nothing is adjusted off unless the denial is valid, so you can be assured you are getting paid the money you deserve.
- Unbundling of procedures. There is often confusion on which surgical procedures are considered inclusive. Unbundling of surgical procedures can be considered fraud and abuse. We work with you understand these rules and avoid scrutiny by payers.
- Extensive Surgery. When extensive surgery is clearly indicated, we get that information to the payer, increasing the likelihood of increased reimbursement.
- Staff training in anatomy and medical terminology. Our billing staff and certified coders have an extensive understanding of medical anatomy and terminology. We have the ability to review your Operative Reports, draft appeal letters, and work with payers to get your claims approved and paid.
- Reporting on Work RVUs. Modifiers, CCI edits, and Assistant Surgeon services all impact the reporting of Work RVUs. If your compensation program is based on WRVUs, you need accurate Work RVU reporting to ensure an accurate paycheck.
Strategic Solutions helps Surgery Practices face today's challenges and achieve financial success in a complex healthcare marketplace. For more information, contact us at 518-348-1276.