A: First, it’s believing that they can do their own billing. If you want a sign of this, ask a few oral surgeons around your office. Its IMPOSSIBLE for dental office staff or oral surgery staff to stay on top of changes in claim-submission protocols that cause predictable claim payments. There are no billing courses on this subject, due to the relatively small volume of billings in this surgical niche compared to medical practices.
These same offices will say Medicare billing doesn’t work when the issue is that HOW THEY BILL doesn’t work. They try to push the blame onto the system versus where it belongs.
Now past the oral surgeon, ask an orthopedic surgeon or an ophthalmologist if they do their Medicare billing in-house and they will laugh you and ask if you are daft. These surgeons understand that it takes ongoing expertise for predictable claim payments.
Starting in 2020, new rule changes further restricted the number of entities having predictable billing success. Our members continue to have success while other implant practices are coming to us in an attempt to restart predictable billing.
The bottom line for this first group is that it is only the pros working full-time at this micro-billing niche are now successful at navigating the payment system and adapting to changes in local rules governing payments.
The second-biggest reason for being unsuccessful at Medicare claims is doctors fail to verify patient benefit eligibility before rendering treatment, and then after surgery discover the patient has no benefits.
Those adhering to the simple verification step and using our professional billing and coding company continue to have predictable success with payments from Original Part B and Medicare Advantage PPO plans.