1. Women’s Health Rights and Cancer Act – you are protected folks.  This is a Federal Mandate.  So all the games insurance companies play hold even less water here.  You are protected for reconstruction (or not) at ALL STAGES including the contralateral breast.  The language of the mandate doesn’t answer every question or address every […]

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- […]

WHICH PLASTIC SURGERY PROCEDURES ACTUALLY PAY (THROUGH INSURANCE)? As a plastic surgeon, it’s likely that you got into this field because you like to help people.  But, realistically, you can’t help every person that walks through your doors and still keep the lights on. To run a successful practice, you have to keep an eye […]

WHAT’S THE DEAL WITH LIPEDEMA BILLING? Covering “borderline” or “grey area” procedures is a constant struggle in plastic surgery billing. Certain insurance companies do certain things. Lines are blurred. Rules are changed. The landscape is ever-changing. Even if you can get something covered, who the heck knows what you’ll be paid…certainly not what you would […]

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 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 […]

Raise your hand if you want to go to school for 15 years and then stand for 8 hours turning a stomach into a breast and get paid $500 per hour for your expertise? Are you familiar with microvascular anastomosis? Yeah, you gotta do that stuff too. Do you skeletonize vessels in your free time? […]

Should I Use A Collections Company / Agency As enticing as sending out “Bruno with the Bat” may sound…there’s a bit more thought to put into the uncollected patient balances you have for more reasons than one. So should you use a traditional/true collections agency? IMHO…you need one…but you shouldn’t be using them if you […]

In an ideal world, your medical practice would 100%  accurate billing with no overpayments (valid or otherwise), refund requests, or automated recoupments. Even with 100% accurate billing…you’re still going to receive all of the above.  It is the unfortunate reality of medical billing today.     The good news is, with better understanding of recoupments and […]

An optimized medical billing process has streamlined payments for all parties. Of course, even the most well-oiled machines quickly grind to a halt when denials occur.