Plastic surgeries have become increasingly popular these days. Several surgical procedures are followed by reconstruction of congenital abnormalities, facial skin, burns, trauma, and body damage. When we hear the term plastic surgery, we think of cosmetic surgeries. But plastic surgery itself is a vast field of medicine. It involves cosmetic and medically necessary procedures, aka reconstructive surgeries. The two terms, plastic surgery and cosmetic surgery are somehow considered the same. But there is a significant difference between the two. Reconstructive plastic surgeries are done due to an injury, trauma, medical condition, or any developmental defect. However, surgeries done to enhance body features fall under cosmetic plastic surgery. These surgeries are often performed to improve one’s physical appearance and self-esteem.
Plastic Surgery Billing Services:
When we talk about medical billing for plastic surgery, cosmetic or aesthetic surgeries (with no medical necessity) are not covered by Medicare. They are categorized as “non-covered”; therefore, the procedure will be denied. There are specific guidelines of coverage by CMS for plastic surgery billing.
Guidelines for Plastic Surgery Billing:
Medicare doesn’t cover cosmetic surgeries performed without any medical necessity, and the procedure is categorized as non-covered. Several cosmetic procedures are not covered by Medicare, for instance:
- Rhinoplasty:
Rhinoplasty is a plastic surgery procedure done to alter the natural shape of the nose. This surgical procedure is done for both reasons; to improve the appearance of the nose or due to any medical necessity like an injury, deviated septum, polyps, or any kind of nasal masses, etc.
In case the rhinoplasty is performed without any medical necessity, the procedure will be considered non-covered and denied. According to CMS, the presence or absence of “signs and symptoms of functional abnormalities” is necessary.
- Reduction Mammoplasty:
According to CMS, if the procedure is performed due to a cosmetic reason, Medicare will not cover it. Therefore, the procedure will be denied as non-covered.
What procedures are covered by Medicare?
There are plastic surgery procedures that can be covered by Medicare based on medical necessity:
– Reconstructive or repairing surgery after an injury, accident, or trauma:
An accident or injury can result in damaging body parts like bones, muscles, or skin. For instance, complex wounds or burns require medical attention, i.e., plastic surgery.
– Surgery on a deformed body part to improve function:
Congenital abnormalities or congenital disabilities limit the normal body functionality of a person. These deformities can be due to any disease impacting a person’s proper body function. Conditions like these might require plastic surgery to improve their functionality.
– Breast reconstruction surgery after a mastectomy due to breast cancer:
Breast cancer patients go through half or complete mastectomy. If you had a mastectomy due to breast cancer, Medicare covers the breast prostheses for breast reconstruction surgery. Breast reconstruction surgery can be done with the help of artificial implants or the patient’s body tissue.
These conditions make plastic surgery medical billing complex. Reconstructive plastic surgery procedures need to be billed following the provided guidelines as they are pretty costly. According to ASPS, almost $16.7 billion were spent on cosmetic surgeries in the United States in the year 2020. But how are people paying for this? The coverage of cosmetic procedures depends on the insurance provider’s conditions. This is why being up to date regarding insurance carriers’ guidelines is necessary when preparing a medical claim.
Which plastic surgeries aren’t covered by Medicare?
Any cosmetic surgery with the sole purpose of altering the appearance (not medically necessary) isn’t covered by Medicare. For instance, cosmetic procedures like:
– Face Lift
– Body Contouring
– Injection of filling material (collagen)
Coding for Plastic surgery:
Coding is extremely delicate when making a medical claim for plastic surgeries or procedures. There’s a line between the procedures covered by Medicare and those that aren’t. The challenge is to know where that line is.
Some reconstructive plastic surgery procedures are comparatively challenging to code. These procedures include breast reconstructive surgery or hand reconstructive surgery. However, cosmetic procedures like rhinoplasty or breast reductions can be hard to get covered by Medicare. These surgeries fall under the grey area (can be cosmetic or needed based on a medical condition).
Importance of Medical Billing for Plastic Surgery:
Hospitals and clinics providing medical services like plastic surgeries aim to provide patients with the best care. And later on, the bill for the medical services was provided for the reimbursements. Plastic reconstructive surgeries are pretty costly, which is why insurance providers consider every perspective before approving the medical claim.
The best option is to outsource plastic surgery medical billing to a well-reputed medical billing company like UControl Billing. Various medical claims get rejected due to inaccuracy in medical codes. There are several CPT codes representing various plastic surgery procedures. Not only this, if the medical claim gets rejected, it makes things even more complicated.
Outsourcing Plastic Surgery Billing Services:
Medical billing and coding play an important role in healthcare practices and their cash flows, which is the reason why outsourcing medical billing is the best solution. UControl Billing provides medical billing services to medical businesses or healthcare providers. With a team of experienced medical billing professionals, medical billing companies help increase the reimbursement rate. Not only do you get lesser errors in medical claims, but outsourcing also decreases the workload. There are several factors due to which healthcare providers outsource their medical billing practices. Following are some of the benefits of outsourcing medical billing services:
– Reduced Billing Errors:
Medical billing comes with several errors resulting in claim denials and a lower reimbursement rate. With outsourced medical billing services, a team of highly experienced medical coders and billers are overlooking the medical claims. Their primary goal is to submit clean claims, improve your revenue cycle, and help your healthcare practice grow.
Medical billing companies are up-to-date with all the changes and updates in medical coding and insurance payer’s guidelines. They make sure to input the right codes and use the right modifiers, all of this in time – reducing late submissions.
– Maximized Reimbursement rate:
The reimbursement rate increases with certified and experienced medical billers reducing medical billing errors. Lesser claim denials mean faster payments and an improved revenue cycle. Which ultimately improves the overall process. Another benefit of outsourcing medical billing is that you won’t have to spend hours on the denied claims.
Medical billing companies like UControl Billing provide timely follow-ups and work to improve your account receivables. So, you can focus on your primary goal.
– Lesser costs:
In-house medical billing team means administrative costs, time spent monitoring the team, fixed costs like salaries, computer equipment, and costs of purchasing and maintaining the medical billing software.
But with outsourced medical billing, you won’t have to worry about fixed costs anymore. Your billing costs will depend on the monthly receipts. Outsourcing to a medical billing company, like UControl Billing, you get competitive and affordable pricing.
– Higher revenues and stable cash flows:
Revenue generation and cash flow stability are crucial for any healthcare practice. The in-house medical billing team means that your medical claims can get delayed if the person is on an off (vacation). Late submissions mean claim denials leading to late payments and a low reimbursement rate.
Medical billing companies submit clean claims in a timely manner to reduce the claim denials. Therefore, higher clean claim rate, improved cash flows, and revenue cycle.
– Increased focus on patient care:
Managing the medical billing and seeing patients at the same time might get complicated. With in-house medical billing, you have to attend to the patients as well as monitor the billing staff.
Outsourcing medical billing means you don’t have to do that anymore. Healthcare providers and physicians can focus more on treating their patients.
How does UControl Billing help in plastic surgery billing?
UControl Billing is a well-reputed medical billing company with a highly specialized and experienced medical billing team on board. We are a result-oriented medical billing company, differentiating and innovating ourselves from the other establishments for our clients. We aim to provide our clients with competitive pricing, improve the revenue cycle, and reduce overall expenses with years of market research.
Why Choose UControl Billing?
We offer 100% discretion, confidentiality, and privacy. We understand that healthcare providers face challenges with medical billing and coding. Which also impacts their day-to-day operations, administrative expenses, and other critical functions. We believe ourselves to be a “remote business office”; we are always available and ready to respond to our client’s queries.
Another best thing, with UControl Billing, you won’t have to choose any other EHR or EMR system. Our team of experienced medical billing professionals can efficiently perform necessary tasks in your existing EHR or EMR system. Our goal is to:
– Maximize your reimbursements
– Improve the account receivables
– Therefore, reducing the overall expenses.
UControl Billing offers HIPAA Compliance. We verify all the medical codes and check their accuracy, so there is no difficulty in processing the medical claim.
Our Pricing:
With in-house medical billing, healthcare providers face fixed expenses. But with UControl Billing, you won’t have to worry about fixed costs anymore. We provide our clients with affordable and competitive pricing. The billing cost will be based on the monthly receipts, meaning we only get paid when you get paid. If your healthcare practice or production faces a dip, your medical billing costs will be with UControl Billing.
Click on the support button to discuss the plan and pricing; UControl Billing team exclusively designs a special pricing plan based on your business requirements.
Our Services:
Medical billing and coding play an important role in any healthcare system. This is why we aim to provide our clients with well-defined medical billing services to help build a profitable and growing healthcare practice. So that you can fulfill your primary goal; providing patient care whilst having overall growth. All of this while keeping you updated, saving your money, and empowering you with control over your medical billing, even with an outsourced one.
Following are the services provided by UControl Billing:
– Medical Billing Services
– Medical Coding Services
– Telemedicine Billing Services
– Revenue Cycle Management (RCM)
– Front Office Management
– Medical Transcription Services
– Medical Credentialing Services
– Value-added services:
o MIPS & MACRA Eligibility
o Medical Billing Reports
Frequently Asked Questions (FAQs)
What is plastic surgery billing in medical billing?
Plastic surgery billing is billing for plastic reconstructive surgeries or procedures. Medical billing for plastic surgery is quite challenging as there are several surgeries that Medicare does not cover. According to Medicare, plastic surgeries without any medical necessity are categorized as “non-covered” and will therefore be denied.
What are common plastic surgery billing errors?
Medicare doesn’t cover plastic surgeries without any medical necessity, and the challenge is to know where the line is. Therefore, billing the non-covered services will be denied—any kind of error like using the wrong codes and incomplete or inaccurate information results in claim denials.
What does plastic surgery billing mean?
There are two kinds of plastic surgeries; reconstructive surgeries and cosmetic surgeries. For instance, plastic surgeries are performed for the reconstruction of a body part due to an injury, trauma, or congenital abnormalities. Note that Medicare covers plastic surgeries with medical necessities.
References:
https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf
https://www.medicare.gov/coverage/cosmetic-surgery#:~:text=Medicare%20covers%20breast%20prostheses%20for,services%2C%20including%20most%20cosmetic%20surgery
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.
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