HOW TO IMPROVE PROFIT IN YOUR SURGERY PRACTICE WITH BETTER BILLING

How to Improve Profit in Your Surgery Practice with Better Billing

How to Improve Profit in Your Surgery Practice with Better Billing

Blog Article

Preface


In today’s competitive healthcare landscape, running a successful surgery practice requires more than just clinical expertise. Financial performance and operational efficiency are essential for sustainability and growth. One of the most critical—but often overlooked—factors in improving profitability is optimizing your billing system.


For general surgery practices, leveraging specialized General Surgery medical billing services along with comprehensive insurance credentialing services can significantly boost your bottom line.


Billing is not merely about sending claims; it encompasses the entire revenue cycle—from patient registration to payment collection. Inefficiencies or errors at any stage can lead to claim denials, underpayments, or delayed reimbursements, all of which negatively impact profitability.


This article outlines practical, proven strategies to enhance your revenue through better billing practices. We'll explore how strategic billing services, robust credentialing, and proactive revenue cycle management can transform your financial outcomes.






Chapter 1: Understanding the Revenue Cycle in Surgery Practices


To improve your practice’s financial health, it’s crucial to first understand the stages of the revenue cycle in a general surgery setting:





  • Patient Registration & Insurance Verification




  • Pre-Authorization & Referral Management




  • Coding & Documentation




  • Claim Submission




  • Payment Posting & Reconciliation




  • Denial Management & Appeals




  • Patient Collections




Each stage has the potential to become a bottleneck. For example, skipping insurance verification can result in services being denied, leading to lost revenue.


This is where specialized General Surgery medical billing services become invaluable. These providers are experts in surgical codes, modifiers, and payer-specific rules. They offer automation and expertise that minimize errors and eliminate inefficiencies.






Chapter 2: Optimize Documentation and Coding


One of the most frequent causes of revenue loss in surgical practices is inaccurate or insufficient documentation. Surgeons, understandably focused on patient care, may under-document case complexity or omit key procedural elements.



Why Coding Accuracy Matters


Proper medical coding ensures that services are accurately translated into billable codes—CPT for procedures, ICD for diagnoses, and sometimes HCPCS for supplies or services.


Specialized billing services offer certified coders trained in surgical procedures, ensuring:





  • Correct use of modifiers (e.g., -51 for multiple procedures)




  • Alignment between diagnosis and procedure codes




  • Proper coding of assistant or co-surgeon roles




  • Consideration of the global surgical period




Improved accuracy boosts claim approval rates, speeds up reimbursements, and reduces audit risks.






Chapter 3: Leverage Insurance Credentialing Services


Credentialing is a critical but often neglected component of revenue optimization. Without proper credentials, a surgeon cannot bill payers—even if fully qualified. Practices frequently face delayed or denied payments due to expired credentials or missed revalidation deadlines.



What Professional Credentialing Services Offer


Outsourced insurance credentialing services can manage:





  • Initial provider registration with commercial payers and Medicare/Medicaid




  • CAQH profile maintenance




  • Re-credentialing and revalidations




  • Hospital and surgical center privileges




  • Contract negotiations and fee schedule reviews




Credentialing ensures your practice can legally and efficiently bill payers and be included in more insurance plans. This not only improves reimbursement but also attracts more patients and referrals.






Chapter 4: Reduce Claim Denials with Proactive Management


Claim denials represent a significant source of lost revenue. According to MGMA, 10–15% of submitted claims are denied, and more than half are never resubmitted.



Common Denial Reasons




  • Inaccurate patient information




  • Lack of prior authorization




  • Coding errors or mismatches




  • Uncredentialed provider




  • Use of incorrect modifiers or non-covered services




Expert General Surgery medical billing services proactively manage denials by:





  • Scrubbing claims to catch errors pre-submission




  • Tracking payer-specific denial trends




  • Managing appeals efficiently and effectively




A dedicated team ensures timely follow-ups, reducing lost revenue from unresolved claims.






Chapter 5: Streamline Patient Billing and Collections


Due to the rise in high-deductible health plans, patient financial responsibility has increased substantially. Patients may be responsible for up to 30% of a surgery’s cost—making collections a key revenue source.



Enhancing the Patient Financial Experience


Patients are more likely to pay when they:





  • Understand their financial responsibility




  • Receive timely, clear statements




  • Have access to online portals and flexible payment options




  • Receive payment reminders




General Surgery medical billing services often include patient engagement tools like digital statements, SMS/email reminders, and secure online payment systems, improving collections and patient satisfaction simultaneously.






Chapter 6: Embrace Technology and Automation


Manual billing processes are outdated, slow, and prone to errors. Modern billing systems use automation to improve efficiency, accelerate reimbursements, and reduce administrative workload.



Essential Technologies




  • Practice Management Software (PMS) – for scheduling, billing, and patient records




  • Electronic Health Records (EHR) – integrates clinical and billing data




  • Revenue Cycle Management (RCM) Tools – tracks claims from submission to payment




  • Telemedicine Billing Integration – supports virtual visits and billing




The best billing services integrate seamlessly with your existing systems, enhancing accuracy and providing real-time analytics for revenue tracking.






Chapter 7: Monitor Key Performance Indicators (KPIs)


To truly optimize profitability, track financial performance through critical KPIs.



Essential KPIs




  • Days in Accounts Receivable (AR) – lower is better




  • First-Pass Claim Acceptance Rate – measures billing accuracy




  • Denial Rate – should be under 5%




  • Net Collection Rate – actual revenue collected vs. allowed amount




  • Patient Collection Rate – reflects effectiveness of patient billing




Outsourced billing partners provide robust reporting dashboards and strategic insights for improvement—not just data.






Chapter 8: Improve Staff Training and Workflow


Even the best tools are ineffective without trained personnel. Success depends on knowledgeable front and back-office teams.



Front Office Training


Focus on:





  • Accurate insurance capture




  • Pre-authorization protocols




  • Clear patient communication




Back Office Optimization




  • Assign specialized roles (coders, submitters, denial managers)




  • Use automation for repetitive tasks




  • Maintain communication between clinical and billing teams




A streamlined, well-trained team ensures fewer errors and faster reimbursements.






Chapter 9: Outsource for Scalability and Expertise


While in-house billing works for some, outsourcing is increasingly popular due to its scalability, cost efficiency, and access to experienced professionals.



Benefits of Outsourcing




  • Certified coders with surgical billing expertise




  • Lower denial rates and faster claim processing




  • Reduced staffing and overhead costs




  • Enhanced reporting and analytics




  • Compliance with evolving payer regulations




Professional insurance credentialing services also ensure contract updates, CAQH profiles, and revalidations are always current—preventing preventable revenue disruptions.






Chapter 10: Ensure Compliance and Audit Readiness


Non-compliance can lead to severe financial and legal consequences. General surgery practices are particularly scrutinized due to high-cost procedures and frequent use of modifiers.


Expert billing providers ensure compliance with:





  • HIPAA regulations




  • Medicare guidelines




  • ICD/CPT code updates




  • Local Coverage Determinations (LCDs)




Maintaining audit-readiness not only protects your practice legally but also strengthens payer relationships and your professional reputation.






Conclusion: The Path to Profit Growth Starts with Better Billing


Improving your surgery practice’s profitability doesn’t require more procedures—it requires optimizing the systems behind your existing services.


By refining billing processes, ensuring coding accuracy, streamlining insurance credentialing, and embracing advanced technologies, your practice can achieve stronger financial performance and greater peace of mind.


Partnering with specialists in General Surgery medical billing services and insurance credentialing services equips you with the tools, knowledge, and support to thrive in a complex healthcare environment.


Treat your billing operations with the same precision and care you give to surgery—because financial health is just as vital as patient health.

Report this page