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The Role of Plastic Surgery Billing Services in Maintaining Revenue Cycle
This Blog Was Originally Published on Unify Healthcare Services
https://www.unifyrcm.com/role-of-plastic-surgery-billing-services.php
One of the industries which have gained a massive boost in recent years is plastic surgery. There are a lot of surgical procedures followed by reconstruction of abnormalities by birth or by an accident like facial skin, burns, trauma, or body damage.
Every time we hear the term Plastic surgery our mind picturizes cosmetic surgeries. However, plastic surgery is a vast field in its own. It includes cosmetic and medically necessary procedures such as reconstructive surgeries.
There are two terms, reconstructive plastic surgery and cosmetic surgery, which are considered the same but have a very significant difference. Reconstructive plastic surgery is used to fix any marks of injury, medical condition, trauma, or any developmental defect.
On the other hand, surgeries done to enhance body features fall under cosmetic plastic surgery. These surgeries are performed to improve or enhance one’s physical appearance and self-esteem.
In this blog, we will learn about plastic surgery billing and how a plastic surgery billing company can simplify it for you.
Plastic Surgery Billing Services
When we talk about plastic surgery billing, be it cosmetic or aesthetic surgeries, it is not covered by Medicare. They are categorized as “non-covered treatments” hence the claim will be denied. There are some specific guidelines of coverage by the Centers for Medicare & Medicaid Services (CMS) for plastic surgery billing
Let’s learn about the guidelines set for Plastic Surgery Billing.
Guidelines for Plastic Surgery Billing
If there is no necessity for any surgery, it will not be covered under Medicare. Such cosmetic procedures are categorized as non-covered. Some examples of Cosmetic surgeries not covered under Medicare are as follows:
Rhinoplasty
Rhinoplasty is a procedure done to change the natural shape of the nose. This surgery is done for both reasons which are to improve the appearance of the nose due to any medical reasons or when any kind of nose mass is developed.
If Rhinoplasty is done without the necessity, the procedure will be considered as non-covered and denied. According to CMS, there should be signs or symptoms of functional abnormalities if it is to be covered by insurance.
Reduction Mammoplasty
Mammoplasty is the procedure to manipulate the breast size in females. This surgery is done due to cosmetic reasons. According to CMS if the procedure is not necessary, it will not be covered under Medicare.
Procedures Covered Under Medicare
Not all plastic surgery is laid off from insurance. The procedures that have medical necessity are covered under Medicare. Determining which treatments are covered and which are not is a crucial part of plastic surgery billing. Let's take a look at some examples.
Reconstructive Surgery After an Accident or Injury
Any accident can result in damaging body parts like bones, skin, or muscles. In some situations when no other option is feasible, and the patient requires plastic surgery, the case is insured under Medicare. For example, complex burns can only be fixed through plastic surgery.
Surgeries of Deformed Body Parts
Disabilities or abnormalities because of any accident or by birth put a limit on the bodily functions of humans. This can also be due to any disease or infection spreading through the body which might hamper proper functioning.
Such conditions require plastic surgery to improve their functionality. The procedures falling under this category are covered by Medicare.
Breast Reconstruction Surgery
This scenario can emerge in females due to mastectomy. Breast cancer patients need to go through half or complete mastectomy. Hence, this procedure is covered under Medicare.
Medicare includes breast prostheses for breast reconstruction surgery. It can be done with the help of artificial implants or the patient’s body tissues.
These are a few examples of the procedures that are covered under Medicare. However, these conditions make plastic surgery billing complex. A biller has to keep in mind and cross check if the procedure performed is covered under the insurance or not. Failing to do so can have a huge impact on your revenue as plastic surgery is an expensive procedure.
The coverage of cosmetic surgery procedures is also dependent on the insurance provider’s conditions. This is why being up to date with all the insurance guidelines is so important while preparing a medical claim. Keep in mind that the slightest discrepancy can result in denial which will be a huge setback for your practice.
Coding for Plastic Surgery Billing
The coding for Plastic surgery is on another level of complexity. There is a thin line between the procedures covered by Medicare and those that are not. Understanding this line requires dedication and years of experience. Even then one must be up to date with the regular changes in the world of Plastic surgery billing.
Some procedures like breast or hand reconstructive surgery have the highest rate of complexity. Whereas cosmetic procedures such as Rhinoplasty or breast reductions are not covered by Medicare. These surgeries lie in a grey area which can be cosmetic or necessary based on the medical condition.
Importance of Plastic Surgery Billing Services
Healthcare organizations that provide plastic surgery services always aim to provide the best service to their patients. Plastic surgery is an expensive procedure, that is why insurance providers check the documentation with scrutiny before approving the claim.
Even the minutest intricacy will lead to denial. Outsourcing your plastic surgery billing to a plastic surgery billing company is the best option for your practice. It will enhance the accuracy in your claims which increases the reimbursement rates for your organization. The complexity level is also very high which requires a dedicated person who takes care of plastic surgery billing and coding.
Benefits of Outsourcing Plastic Surgery Billing
Plastic surgery billing is an important factor for maintaining the revenue flow within an organization. It requires a high level of precision and expertise because of the complexity. This is where Plastic Surgery Billing Company such as Unify Healthcare Services plays its part.
Unify Healthcare Services provides billing services for a lot of niches. It has trained experts who are well-versed in all the billing and coding guidelines set by the government as well as the insurance companies.
It will help your business grow by:
Diminishing Billing Errors:
Once you partner with a plastic surgery billing company you can simply forget billing and focus your attention towards providing the best patient care. The experts will handle your entire claim process like magic. You will automatically see growth in your revenue which will give you peace of mind.
Maximized Reimbursement Rates:
If your claims are error free it is obvious that your claims will be reimbursed appropriately. Fewer claim denials mean faster payments and an enhanced revenue cycle. It also means that you won’t have to spend hours to fix the denied claims. The experts will take care of that.
Lesser Costs:
Hiring an in-house team for plastic surgery billing means that you will have to provide the resources as well as infrastructure, which just adds to the administrative costs. Every plastic surgery billing company has already set up the infrastructure and has ample amount of resources. All you will have to pay is for the service.
Higher Revenue & Stable Cash Flow:
Healthcare is a noble profession but, in the end, it also needs a stable cash flow to survive in the market. If you have an in-house team, you still are prone to mishaps due to a variety of reasons such as leave of employees, late submission, minimal errors, etc. A plastic surgery billing company manages its resources in a way that the workflow is never hampered. They always focus on timely and accurate billing.
Increased Focus on Quality Patient Care:
Managing billing along with visiting patients becomes difficult. It gets very complicated and hectic for the providers. It might also irritate the patient resulting in low footfall. Once you outsource plastic surgery billing to experts you don’t have to go through the hassle of documentation and focus solely on providing quality patient care.
These are some of the benefits of partnering with a plastic surgery billing company to take care of your organization’s plastic surgery billing. It reduces a lot of burden from your shoulders so that you can focus entirely on providing better patient care.
Unify Healthcare Services envisions making billing easy for every individual practitioner as well as healthcare organizations. We believe that every patient should get the best treatment, which is possible only when the healthcare provider has peace of mind.
Good healthcare is the right of every individual and proper reimbursement is the right of every healthcare provider.
https://www.unifyrcm.com/role-of-plastic-surgery-billing-services.php
One of the industries which have gained a massive boost in recent years is plastic surgery. There are a lot of surgical procedures followed by reconstruction of abnormalities by birth or by an accident like facial skin, burns, trauma, or body damage.
Every time we hear the term Plastic surgery our mind picturizes cosmetic surgeries. However, plastic surgery is a vast field in its own. It includes cosmetic and medically necessary procedures such as reconstructive surgeries.
There are two terms, reconstructive plastic surgery and cosmetic surgery, which are considered the same but have a very significant difference. Reconstructive plastic surgery is used to fix any marks of injury, medical condition, trauma, or any developmental defect.
On the other hand, surgeries done to enhance body features fall under cosmetic plastic surgery. These surgeries are performed to improve or enhance one’s physical appearance and self-esteem.
In this blog, we will learn about plastic surgery billing and how a plastic surgery billing company can simplify it for you.
Plastic Surgery Billing Services
When we talk about plastic surgery billing, be it cosmetic or aesthetic surgeries, it is not covered by Medicare. They are categorized as “non-covered treatments” hence the claim will be denied. There are some specific guidelines of coverage by the Centers for Medicare & Medicaid Services (CMS) for plastic surgery billing
Let’s learn about the guidelines set for Plastic Surgery Billing.
Guidelines for Plastic Surgery Billing
If there is no necessity for any surgery, it will not be covered under Medicare. Such cosmetic procedures are categorized as non-covered. Some examples of Cosmetic surgeries not covered under Medicare are as follows:
Rhinoplasty
Rhinoplasty is a procedure done to change the natural shape of the nose. This surgery is done for both reasons which are to improve the appearance of the nose due to any medical reasons or when any kind of nose mass is developed.
If Rhinoplasty is done without the necessity, the procedure will be considered as non-covered and denied. According to CMS, there should be signs or symptoms of functional abnormalities if it is to be covered by insurance.
Reduction Mammoplasty
Mammoplasty is the procedure to manipulate the breast size in females. This surgery is done due to cosmetic reasons. According to CMS if the procedure is not necessary, it will not be covered under Medicare.
Procedures Covered Under Medicare
Not all plastic surgery is laid off from insurance. The procedures that have medical necessity are covered under Medicare. Determining which treatments are covered and which are not is a crucial part of plastic surgery billing. Let's take a look at some examples.
Reconstructive Surgery After an Accident or Injury
Any accident can result in damaging body parts like bones, skin, or muscles. In some situations when no other option is feasible, and the patient requires plastic surgery, the case is insured under Medicare. For example, complex burns can only be fixed through plastic surgery.
Surgeries of Deformed Body Parts
Disabilities or abnormalities because of any accident or by birth put a limit on the bodily functions of humans. This can also be due to any disease or infection spreading through the body which might hamper proper functioning.
Such conditions require plastic surgery to improve their functionality. The procedures falling under this category are covered by Medicare.
Breast Reconstruction Surgery
This scenario can emerge in females due to mastectomy. Breast cancer patients need to go through half or complete mastectomy. Hence, this procedure is covered under Medicare.
Medicare includes breast prostheses for breast reconstruction surgery. It can be done with the help of artificial implants or the patient’s body tissues.
These are a few examples of the procedures that are covered under Medicare. However, these conditions make plastic surgery billing complex. A biller has to keep in mind and cross check if the procedure performed is covered under the insurance or not. Failing to do so can have a huge impact on your revenue as plastic surgery is an expensive procedure.
The coverage of cosmetic surgery procedures is also dependent on the insurance provider’s conditions. This is why being up to date with all the insurance guidelines is so important while preparing a medical claim. Keep in mind that the slightest discrepancy can result in denial which will be a huge setback for your practice.
Coding for Plastic Surgery Billing
The coding for Plastic surgery is on another level of complexity. There is a thin line between the procedures covered by Medicare and those that are not. Understanding this line requires dedication and years of experience. Even then one must be up to date with the regular changes in the world of Plastic surgery billing.
Some procedures like breast or hand reconstructive surgery have the highest rate of complexity. Whereas cosmetic procedures such as Rhinoplasty or breast reductions are not covered by Medicare. These surgeries lie in a grey area which can be cosmetic or necessary based on the medical condition.
Importance of Plastic Surgery Billing Services
Healthcare organizations that provide plastic surgery services always aim to provide the best service to their patients. Plastic surgery is an expensive procedure, that is why insurance providers check the documentation with scrutiny before approving the claim.
Even the minutest intricacy will lead to denial. Outsourcing your plastic surgery billing to a plastic surgery billing company is the best option for your practice. It will enhance the accuracy in your claims which increases the reimbursement rates for your organization. The complexity level is also very high which requires a dedicated person who takes care of plastic surgery billing and coding.
Benefits of Outsourcing Plastic Surgery Billing
Plastic surgery billing is an important factor for maintaining the revenue flow within an organization. It requires a high level of precision and expertise because of the complexity. This is where Plastic Surgery Billing Company such as Unify Healthcare Services plays its part.
Unify Healthcare Services provides billing services for a lot of niches. It has trained experts who are well-versed in all the billing and coding guidelines set by the government as well as the insurance companies.
It will help your business grow by:
Diminishing Billing Errors:
Once you partner with a plastic surgery billing company you can simply forget billing and focus your attention towards providing the best patient care. The experts will handle your entire claim process like magic. You will automatically see growth in your revenue which will give you peace of mind.
Maximized Reimbursement Rates:
If your claims are error free it is obvious that your claims will be reimbursed appropriately. Fewer claim denials mean faster payments and an enhanced revenue cycle. It also means that you won’t have to spend hours to fix the denied claims. The experts will take care of that.
Lesser Costs:
Hiring an in-house team for plastic surgery billing means that you will have to provide the resources as well as infrastructure, which just adds to the administrative costs. Every plastic surgery billing company has already set up the infrastructure and has ample amount of resources. All you will have to pay is for the service.
Higher Revenue & Stable Cash Flow:
Healthcare is a noble profession but, in the end, it also needs a stable cash flow to survive in the market. If you have an in-house team, you still are prone to mishaps due to a variety of reasons such as leave of employees, late submission, minimal errors, etc. A plastic surgery billing company manages its resources in a way that the workflow is never hampered. They always focus on timely and accurate billing.
Increased Focus on Quality Patient Care:
Managing billing along with visiting patients becomes difficult. It gets very complicated and hectic for the providers. It might also irritate the patient resulting in low footfall. Once you outsource plastic surgery billing to experts you don’t have to go through the hassle of documentation and focus solely on providing quality patient care.
These are some of the benefits of partnering with a plastic surgery billing company to take care of your organization’s plastic surgery billing. It reduces a lot of burden from your shoulders so that you can focus entirely on providing better patient care.
Unify Healthcare Services envisions making billing easy for every individual practitioner as well as healthcare organizations. We believe that every patient should get the best treatment, which is possible only when the healthcare provider has peace of mind.
Good healthcare is the right of every individual and proper reimbursement is the right of every healthcare provider.