All Medicare beneficiaries, have the right to choose their own doctors and other healthcare providers. But if you are a physician who has opted out of the Medicare program, there are a few things you should know. First of all, what does it mean to opt out of Medicare? Essentially, it means that a physician has chosen […]

THE QUESTION: THE PATIENT HAD TOLD ME THEY’RE OK MOVING FORWARD COSMETIC AND HAVE NOW BILLED THE INSURANCE COMPANY ON THE BACKEND, FORCING US INTO THE BILLING PROCESS. ANY WAY TO AVOID THIS IN FUTURE? We were asked a really good question about insulating against patients submitting self-pay cases to their insurance after the fact- […]

THE QUESTION: I HAVE A PATIENT IN NEED OF SURGERY WITH WORKMAN’S COMP COVERAGE (WC). WILL I GET COMPENSATED FOR THIS? SHOULD I CONTINUE TO TAKE WC? THE ANSWER Will you be compensated? The short answer is yes. WC is not a network-based coverage plan.  So long as they has a claim number from her […]

The short answer? Yes. “Med” is in fact short for “Medical,” and therein lies your ability to bill insurance in a med spa. You might ask, “Why would I bother to bill insurance when I could just charge cash pay only and rake it in?” Our answer: Why play checkers when you should be playing […]

THE ANSWER: How many patients who come to you for a “septoplasty” have zero desire for a positive aesthetic outcome?  Like they care 0% about how they look after surgery and are seeing you solely because their deviated septum has robbed them of their ability to breathe?   None.  They might say they don’t care, but […]

“The day you can fire me is one of the happiest days in our relationship” – Famous last words from John Gwin, CEO of The Auctus Group But seriously…why should you care? You’re a cosmetic / aesthetic surgeon. You’re making 2-3K+ per hour. Why would you ever lose money to deal with insurance? …Because you […]

THE ANSWER: Almost all payers, including Medicare/Medicaid DO cover/WILL cover REMOVAL of implants placed for any reason w/ Bakers III+ and/or Rupture.  PAY ATTENTION HERE: they cover ONLY removal of implant/extracapsular material, perhaps capsulectomy/capsulotomy, and NOT revision/replacement UNLESS there’s a personal history of breast cancer or mastectomy for prophylaxis.   So…tell that patient we can […]

THE QUESTION: I’M THINKING ABOUT HIRING A NURSE PRACTITIONER OR PHYSICIAN ASSISTANT…HOW DOES THE BILLING WORK? THE ANSWER: Great question! Long answer…I’m going to make more questions than I answer here I think… Can the midlevel bill under the MD? In short, yes…but you have to be careful and adhere to the regulatory guidelines. This […]

So, I got an email from a client, with a great question and thought I would share our reply! The Question: What the average insurance pay-out is for a small in office cyst or lipoma removal. Wondering if we should be submitting or billing cosmetically? The Answer: Good question. They are medically necessary procedures typically […]

Medical billing and coding are essential to running a practice. These systems impact patient safety and accounts receivable, as well as operations and efficiency. If not optimized, coding can directly affect your bottom line.

This blog explores common medical billing and coding challenges and provides suggestions for improvement.