Medical billers and medical billing services are the financial life blood of a practice. Practices that do not have the right medical billing expertise in their corner can easily lose more than 20 percent of their practice’s potential revenue.

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.

Medical billing is a highly complex area and it requires experience-based knowledge and expertise to contend with insurance companies. When it comes to surgical billing, the situation gets even more complex. Such complexity can be handled only by a company that is staffed with well trained surgery billing professionals. The medical billing specialist must be familiar with the specific codes and rules that make up the world of surgery billing.

As the cost of providing surgery related healthcare services continues to rise, medical institutions and surgical practices cannot afford to leave revenue uncollected by billing companies or freelancers that are not knowledgeable in surgical billing. It is also important to keep in mind some companies may promote themselves as large surgery billing service providers but in reality they sub-contract the surgery billing to freelancers who work from home. Hiring such companies will lead to lost revenue because of the lack of proper process, controls, and training.

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.

It is not only insurance billing that is more complicated for surgeons; patient billing is also more difficult. The patients often have high balances, complicated explanations from their payers and do not understand all of the invoices they are receiving from their surgeon, the hospital or ASC and the anesthesiologist. A billing company that has strong surgical billing experience has spoken with patient about these topics many times before. A less skilled patient collection effort could leave the surgeon with less money and unhappy patients.

The safest way for a surgeon to navigate the medical billing land mines outlined in this article I to travel the medical billing battlefield with a surgical billing service that has deep and proven expertise in traversing the surgery billing hazards. Family doctors should not be performing surgery and generalist medical billing companies should not be providing medical billing services to surgeons.

Copyright 2008 by Carl Mays II