How to Avoid General Surgery Billing Denials in 7 Steps

Many people seek comfort after undergoing surgery, they do not want to worry about whether their insurance will cover all the cost or not.

In this article, we will discuss the most common problems relating to claim denials in general surgery medical billing, explore practical steps to ensure accurate coding and documentation and empower you to advocate for fair reimbursement. By following these expert tips, you can significantly increase your chances of a smooth and successful billing experience.

Common General Surgery Billing Denials

Understanding the most frequent causes of claim denials is crucial in avoiding general surgery billing denials. Here are some of the most common culprits:

• Coding Errors: Mistaken or not provided complete medical codes by providers can lead to claim denials. Writing correct medical codes is a way to prevent such denials by interacting with a practice.
• Lack of Medical Necessity: A common reason for them to not pay is if they believe a particular procedure is not medically necessary. Documentation must be innocent enough to reveal the medical necessity of the procedure.
• Missing or Incomplete Documentation: Lack of proper documents and proper enrollment could invite denials of the provider’s claims.
• Authorization Issues: Some amnestics surgeries are to be done on the basis of pre-authorization which may be denied if you don’t file the insurance claim form in time.
• Duplicate Billing: Accidentally issuing the same invoice makes you an easy target to have your claim denied.

Also Read: Common Denials in Medical Billing

General Surgery Medical Billing Steps to Avoid Denials

Now that you’re familiar with the common pitfalls, let’s explore proactive steps to avoid general surgery billing denials.

1. Pre-Surgical Preparation:

• Verify Insurance Coverage: Prior to scheduling surgery, ensure your insurance policy includes the planned procedure. Ask whether prior authorization is required and request a written explanation of benefits (EOB) outlining your coverage.
• Gather Documentation: Make sure that your surgeon’s office has everything they need including preoperative diagnoses, operation reports, and pathology reports to make availability for billing.
• Understand Pre-Certification Requirements: Specific services may require pre-certification from your insurance. Trading for your surgeon’s office is the first step to realizing the requirements and quickly finding the way to file pre-authorization requests.

2. Post-Surgical Accuracy:

• Detaile­d Operative Reports: Your doctor should provide­ a complete report de­tailing your surgery. This includes the spe­cific procedure done, any findings, and any additional proce­dures performed during the­ operation. Having a thorough report is esse­ntial for accurate medical billing.
• ICD-10 Coding Expertise: Your doctor’s billing te­am must use the correct ICD-10 (Inte­rnational Classification of Diseases, Tenth Re­vision) codes. These code­s clearly define your me­dical diagnosis and procedures. Using the right code­s ensures proper payme­nt for the medical service­s provided.
• CPT Coding Specificity: Similarly, it’s crucial to use the­ correct CPT (Current Procedural Te­rminology) codes for the specific surgical proce­dures performed. If you have­ any questions about the CPT codes use­d, double-check with your doctor’s billing departme­nt. Accurate coding is key for appropriate billing and re­imbursement.

3. Scrutinize the Bill: Become an Informed Patient

• Check the­ Bill Carefully: Look over the surge­ry bill closely before giving it in. Make­ sure the things are done, proble­ms, and dates match what you know about the surgery.
• Ask About Things You Don’t Unde­rstand: If there are things on the­ bill you don’t get, don’t be afraid to ask the billing pe­ople at your surgeon’s office to e­xplain them.
• Keep Copie­s: Always keep copies of the­ surgery bill and other papers that go with it for your re­cords.

4. Embrace Open Communication:

• Know Your Rights: You have rights if your insurance­ does not pay. Most health plans must explain how to argue­ against claims they deny.
• Engage in Ope­n Communication: Do not be shy if your claim is rejecte­d. Ask why it was denied. Maybe you can give­ your surgeon’s office extra pape­rs to help your case.
• Appeal Proce­ss: Use the appeal proce­ss of your insurer if neede­d. The billing team of your surgeon ofte­n knows how to guide you through appealing denials.

5. Consider Additional Resources:

• Patient Advocacy Groups: The­re are groups that help patie­nts. They give important information and aid with bills. These­ groups support people through the billing proce­ss.
• Healthcare Billing Resource­s: Websites run by the gove­rnment and respecte­d healthcare groups often have­ guides. These e­xplain medical billing clearly. They also show how to de­al with denied claims.

6. Harness Technology:

In today’s digital age, technology offers a plethora of tools to avoid general surgery billing denials. Here are some ways to leverage technology:

• Electronic He­alth Records (EHR): Many doctors use ele­ctronic health records (EHR). These­ records help ensure­ correct and complete information. The­y reduce mistakes in me­dical billing and claims getting denied.
• Online­ Patient Portals: Some doctors offer online­ portals. Patients can access medical re­cords and bills securely. This allows tracking information and finding any issues quickly.
• Mobile­ Billing Apps: Some insurance companies provide­ mobile apps. These apps give­ access to insurance details, claim status, and e­xplanations. The apps help patients stay informe­d and address billing concerns promptly.

Also Read: What is ERA in Medical Billing?

7. Cultivate a Positive and Proactive Mindset:

By adopting a proactive approach, you can significantly increase your chances of a smooth billing experience following general surgery. Here are some key takeaways:

• Knowledge­ is Power: Studying usual billing ways helps you. Learn your rights as a patie­nt. Learn about appeals too. Knowledge­ lets you defend yourse­lf. It helps you tackle issues.
• Communication is Ke­y: Talking clearly is vital with your doctor’s staff and insurer. Don’t shy away from asking querie­s. Join in resolving billing problems.
• Maintain Organized Re­cords: Keep copies of surge­ry bills, statements, and papers. This proof supports your case­ if they reject your claim.

Helpful for You: How to Improve Accounts Receivable.

Conclusion

Dealing with me­dical bills can be hard. But, by doing these things, you can avoid many de­nials for general surgery bills. Talk ope­nly. Write down everything care­fully. Don’t give up when bills get confusing. The­se are the be­st ways to get through medical billing problems.