While plastic surgery is commonly associated with improving one’s appearance, it is often performed to treat actual medical issues. Additionally, a single treatment session frequently combines both cosmetic and reconstructive procedures to address health issues. Due to the complicated nature of plastic surgery, both patients and surgeons may face significant challenges. Surgical procedures conducted only for aesthetic reasons are typically not reimbursed by insurance, but those performed to treat actual medical conditions are.

This results in inaccurately confirming insurance eligibility, which frequently means spending time filing claims for procedures for which insurance is not eligible or forgetting to include parts of a surgical procedure that are covered by insurance. Both situations have an impact on the plastic surgeon’s or the clinic’s earnings.

Outsourcing to PBC:

PBC’s medical billing and coding services take care of every step of the insurance-claim process for plastic surgery, from patient eligibility verification to claim filing and follow-ups afterward. Our medical billers and coders have years of expertise handling plastic surgery cases in particular as well as preparing and submitting insurance claims in general. They are aware of the size and scope of your business and can tailor a strategy to meet your unique requirements. It enhances your financial situation while assisting you in fulfilling your administrative and technical obligations related to the preparation and filing of claims.

PBC provides this in two ways: first, through a consulting model in which it assists you in streamlining your revenue management cycle by suggesting suitable software programmes, helping to plug revenue leakages and providing trainings as needed, and, second, by outsourcing all of your billing and coding duties to PBC.

Our billers and programmers suggest certain popular procedures that may be contributing factors to your income leakage:

Reconstruction of the Breast:

While it is a form of plastic surgery, it is primarily a difficult reconstructive or medical treatment where the patient faces substantial health risks and prolonged suffering if the accompanying concerns are not appropriately addressed. Due to the nature of the surgery, the doctor frequently faces the difficulty of determining which portions of the process are Medicaid-covered and which aren’t. Our medical billers and coders are skilled at managing these nuances and will assist you in putting together a strong claim that has little likelihood of being rejected.

Palatoplasty : 

A surgery to repair cleft palate, this technique involves aspects that are not just cosmetic but reconstructive presenting the problem to physicians or clinicians to identify such parts of the operation as would be eligible for insurance payment. Our medical billers are coders are competent in helping you conclusively differentiate the elements of the operation that have reconstructive character and consequently insurance eligibility from components that don’t.

Blepharoplasty: 

Although mostly a cosmetic operation, correcting hooded eyelids involves surgery to fix a deficiency that may cause injury to the eye, thus requiring reconstruction in certain areas. To make sure you get paid for the reconstructive portions of the treatment, we assist you in identifying them.

Nose surgery or rhinoplasty:

It entails realigning a portion of the nose that may not operate properly if it is misaligned. But because rhinoplasty is primarily a cosmetic procedure, doctors frequently forget about this reconstructive component, which is covered by insurance.

By helping them to concentrate only on healthcare or by offering consulting services so that they can handle their revenue management responsibilities more effectively with the help of appropriate software applications and simpler, more streamlined processes, PBC’s billing and coding professionals have significantly reduced the insurance denial rates of plastic surgery providers, resulting in timely payment of their services and optimal use of their staff.

By taking over what PBC does best, PBC will assist you in doing the ideal plastic surgery, freeing you up to focus on what you do best surgery.