Medical billing for surgeons can be complicated because it often involves several item numbers, Medicare rules, and detailed records. Accurate billing helps prevent delays, underpayments, or rejected claims. Surgeons and their staff need to know how to record procedures clearly, link related services, and follow the latest Medicare guidelines. Using simple and practical steps can make the billing process easier and support timely reimbursements.
Use the Correct Surgical Item Numbers
Every surgical procedure has a specific item number listed in the Medicare Benefits Schedule (MBS). Using the correct item number is important because it shows what service was done and determines how much can be claimed. Some surgeries include more than one step or are combined with other procedures, which may need extra item numbers. It is also important to check Medicare’s rules about which item numbers can be billed together and which cannot. Using the wrong item number can result in claims being rejected or paid at a lower rate. Surgeons and billing staff should always refer to the latest MBS to stay updated and avoid mistakes.
Record All Details Clearly and Accurately
Clear and accurate records are important for successful billing. Notes should include the type of surgery, the date and time it was done, and any extra details needed to support the claim. Medicare may request this information during a review or audit. Keeping records complete and easy to understand helps reduce the risk of claims being delayed or questioned. For more complex surgeries, adding notes to explain why certain item numbers were used can also help avoid payment issues.
Link Related Services Correctly
Surgical billing often needs to be connected to related services, such as anaesthetic care or assistant surgeon fees. Linking these correctly shows that all claims are part of the same procedure. If these links are missing or incorrect, Medicare may reject the claim. Billing staff should check that provider numbers, item numbers, and service dates match across all related claims. Taking this extra step helps prevent errors, reduces confusion, and supports faster claim processing.
Follow Medicare Billing Rules and Restrictions
Medicare has clear rules about how surgical services can be billed. Some item numbers cannot be used together, and certain procedures have limits on how often they can be claimed. Surgeons also need to know the rules for billing multiple operations in one session, as these may lead to reduced fees or extra requirements. Regularly checking Medicare guidelines and training staff on these rules can help prevent errors. This reduces the risk of audits or repayments and helps keep billing compliant.
Submit Claims Promptly
Sending claims soon after the service helps ensure payments are processed without delay. Submitting claims can be a detailed process, especially since Medicare and health funds often have strict time limits and specific requirements. Late submissions can lead to missed deadlines or extra work to correct and send claims again. Setting a regular routine—such as sending claims daily or weekly—can keep billing organised and up to date. This also makes it easier to track unpaid claims and fix any issues quickly.
Review and Follow Up on Unpaid Claims
Claims can sometimes be delayed or left unpaid. This may happen because of missing information, wrong item numbers, or differences in patient details. Checking unpaid claims regularly helps find these issues early so they can be fixed and sent again. Using a simple system to track pending claims makes it easier for staff to follow up quickly. This helps reduce missed payments and supports steady cash flow for the practice.
Consider Using Electronic Billing Systems
Electronic billing systems can help manage medical billing for surgeons more quickly and with fewer mistakes. They store patient and procedure details, check for missing or incorrect information, and work out fees using the right item numbers. These systems also make it easier to track claims and see which ones are unpaid or need follow-up. For practices still using manual billing, moving to an electronic system can save time and help staff avoid errors. Regular updates to the system ensure it stays in line with Medicare rules.
Why Choose Medbill for Surgeons’ Services in Australia
Medbill provides medical billing services for surgeons and other healthcare providers across Australia. Their team understands the specific requirements of medical billing for surgeons, including the use of correct item numbers, linking related services, and following Medicare rules. By managing these complex tasks, they help reduce errors and support faster, more accurate claims processing.
Surgeons often face challenges with time-based billing, multiple procedure rules, and strict documentation standards. Medbill uses systems that check claims for missing or incorrect details before submission, helping to prevent delays and rejections. They also keep up to date with changes to the Medicare Benefits Schedule (MBS) to ensure claims remain compliant.
With over $1 billion in medical claims and billing initiatives managed, Medbill has the experience to handle high volumes of surgical claims efficiently in Australia. They help surgeons keep their billing organised and accurate. Their services are designed to meet Australian healthcare standards while allowing surgeons to focus on patient care.
