How Can Practices Clearly Differentiate Cosmetic and Medically Necessary Procedures to Avoid Denials?

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Practices can avoid denials by clearly differentiating cosmetic and medically necessary procedures through accurate documentation, proper coding, and transparent patient communication. In specialties like dermatology and plastic surgery, confusion between cosmetic procedures and medically necessary procedures is a leading cause of claim denials and payment disputes. Clear differentiation protects both revenue and compliance. What Is the Difference Between Cosmetic and Medically Necessary Procedures? A cosmetic procedure is performed to improve appearance and is typically not covered by insurance. A medically necessary procedure is performed to diagnose, treat, or manage a medical condition and may qualify for reimbursement. Insurance carriers require clear evidence that a service meets medical necessity criteria before approving payment. Why Do Claims Get Denied When Procedures Are Not Clearly Differentiated? When documentation does not clearly support medical necessit...
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General Surgery Medical Coding Steps to Avoid Denials

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Physicians in general surgery are facing an uphill task of medical billing keeping in check the different needs of the facilities and keeping a tab on the effective revenue cycle management to look for frequent denials and which of the claims need more efficient coding. The channel of insurance payment has been one of the most straining factors for general surgery physicians today affecting the bottom line of the revenue and in turn affecting the facility.  Individual physicians have the high cost of staffing and also revenue management which has led to many of them being absorbed by groups acquired by the hospital. General Surgery is one such facility that has seen a rise in individual costs and most of the facilities are either in the group or combined with hospitals.

Tracking different types of patient care from appointment scheduling to registration and different steps for collection of the balance fall under the revenue cycle management. The healthcare revenue cycle is a financial system that has brought in the work of administrative and clinical functions associated with billing. The process happens to take into consideration different data points which are coded into a format that helps the understanding of an insurance company. These codes are usually laid by the Center for Medicare and Medicaid Service (CMS) and also the price value of each procedure or diagnostic is decided beforehand to help cover the cost and also a margin of profit for the doctors.

If you want to read the complete blog then click below: General Surgery Medical Coding Steps to Avoid Denials


Location: Louisiana, USA

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