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We have great expertise in accurately coding diverse cosmetic procedures with the appropriate surgical and E/M modifier codes. Our team comprises CPRC, AHIMA, and AAPC-approved CCS, CCS-P, and CPC-certified coders and billers with firsthand experience in navigating plastic surgery billing complexities. Leveraging their extensive expertise and knowledge of billing software, we will streamline your plastic surgery billing process to enhance your practice's cash flow. Here's our approach:
- Modernize your pathology billing with seamless integration of EHR/EMR, EDI, and other tools with plastic surgery-specific software for fast and accurate electronic claims submissions and electronic payments.
- Gather all patient information, including demographics, medical history, and referrals, and verify comprehensive insurance details, such as coverage status, prior authorization validity dates, and claims address.
- Handle pre-authorization requests, providing detailed clinical justification of services to avert clearinghouse rejections and minimize the chances of claims denials.
- Align with regulatory requirements while handling cosmetic surgery financing bills, value-based bills, litigation or personal injury billing, fee-for-service billing, etc.
- Align the electronic claims processing workflow with appropriate codes and modifiers (11950–17380 cosmetic procedure CPT code range, 15780-30450 CPT/HCPCS code range, ICD-10-CM codes).
- Maintain code specificity and payer guidelines while billing for plastic surgery procedures, including facelifts or brow lifts, rhinoplasty, liposuction, abdominoplasty, breast augmentation, body contouring procedures, palatoplasty, blepharoplasty, and others.
- Adhere to fee schedules and payment guidelines specific to insurance payers (Medicare, Medicaid, ACA plans, Tricare, workers' compensation plans, and private insurers such as Cigna, Humana, Aetna, etc) while submitting claims.
- Engage with insurance payers to review Explanation of Benefits (EOBs), ensuring thorough patient benefits verification and gaining insights into each individual's deductibles, copayments, and coinsurance.
- Analyze the EOBs meticulously to identify any payment discrepancies, resolve them, and initiate the appeals process accordingly.
- Inform patients about their payment responsibilities to prevent unpaid bills for our clients.
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