Coding and medical billing are not as intricate for many other specialties as for general surgery. General surgery comprises many surgical procedures, including: kidney surgery; pancreas, thoracic, and abdominal surgery; liver transplantation; gastrointestinal tract surgery; elective surgery; and breast surgery. General surgery itself is a complex and vast territory of health care that includes numerous sub-specialties, and the related billing for each specialty can be critical and challenging. In order to handle the complexity of the specialty, the billing and coding staff need to be knowledgeable in the proper use of the global surgical package, modifiers for surgeon roles and same-day procedures, and citations for unlisted procedures. Mistakes can lead to lower reimbursements and cause compliance issues. Decreases in cashflow and the high cost of staffing have led to many physicians being absorbed by groups acquired by hospitals. General surgery is one such specialty that has seen the rise of individual costs, and most facilities are either in groups or combined with hospitals.
General surgery providers see losses in their cashflows for many reasons:
- Small coding errors in diagnosis and procedures can lead to revenue losses and growth in denials from insurance companies.
- An error in understanding and analyzing codes and guidelines can lead to 80% denial.
- Minor billing mistakes can cause practitioners to wait for many months to get reimbursed for offered services.
- There is a rise in A/R denial and lack of timely follow up.
- General surgery coding-trained billing staff have a high cost.
At CMM, we stay abreast of changes in diagnosis, procedure codes, modifiers, global period, and guidelines.Our regularly updated software eliminates 90% of human errors, hence, generating a clean claim the first time.