Thoracic surgical specialty is one of those priority specialties that have always been in high demand across the 50 states in the U.S., and the forecast is for an increased incidence of thoracic surgical cases. While practitioners in thoracic surgical specialty may continue to be optimistic about their future practice, constant clinical innovations and complexity of the procedures would still have to be taken care of. Thoracic surgery often involves preoperative, operative, and surgical critical care of patients with problems within the chest. The magnitude of focus leaves physicians confined to clinical care alone, leaving them largely ignorant of finer aspects of Thoracic medical billing & coding, and reimbursement management.
A specialty as complex and critical as Thoracic surgery requires physicians to be conversant with the entire process of Thoracic medical billing, beginning with:
- Ability to read and abstract physician office notes and operative notes to apply correct ICD-CM, CPT, HCPCS Level II and modifier coding assignments
- Evaluation and management (both the 1995 and 1997 Documentation Guidelines)
- Rules and regulations of Medicare billing including (but not limited to) incident to, eaching situations, shared visits, consultations and global surgery
- Coding of surgical procedures performed
- Knowledge of Medical terminology associated with Thoracic specialty
- Complete proficiency in Thoracic Anatomy and physiology
They may further be required to:
- Customize and generate HIPAA compliant claim codes as per situational needs that vary depending upon on patients’ health insurance coverage under Medicare, Medicaid, or private health insurance policies.
- Create separate reports for diagnosis, treatment, and procedures.
- Function in collaboration with major healthcare Insurances such as Medicare, Medicaid, and a host of private insurers such as Oxford, United, Aetna, Hip, No Fault, Medicaid, Humana, etc.
- To be certified by certified by the AAPC (American Association of Professional Coders) and conform to coding norms as defined by AMA and CMS.
- To be comfortable with generating medical codes on both paper and electronic formats. In addition, they should also be trained on medical billing and coding software to generate instant medical billing reports.
- Have a thorough A/R management in place to monitor, track, and expedite the claims within the permissible time limit
- Take up delayed or rejected claims with appropriate arbitrary…