Coding and Billing for Colon and Rectal Surgery

Abstract

Physicians nationwide are experiencing increasing difficulty resolving medical claims. Many physician offices still process medical claims manually through the mail. This delays reimbursement for up to 4 months. The claim process is expedited by using electronic submission. Today, claims require more detailed patient information and precise data entry unique to each insurance carrier. Misinformation delays reimbursements, and insuring agents deny or delay payment of claims for increasingly petty reasons. They commonly assert that procedures were “not precertified,” are “not medically necessary,” or constitute “experimental treatment” or that the charges “extend beyond the reasonable and customary norms.” Even more frustrating, the cost of reprocessing a denied claim is five to ten times greater than that of the original claim.