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Expedite your Reimbursement

One of the most efficient ways to expedite timely reimbursement is to conduct proper verification and pre-certification of services. So often, surgery centers are short staffed and reluctant to spend time on the phone verifying coverage. The following steps will result in prompt payment along with clean claims to the insurance carriers.

• Develop a verification and precertification form and policy.

• Document the entire process and whom your staff spoke to at the carrier. If more than, 14 days have lapsed since the patient’s last visit, repeat procedures.

• If the patient has a high deductible, collect the balance prior to services.

• If the insurance company pays poorly, you might consider referring the patient to another center.

• The center should identify the top payors and top procedures; determine if the services are payable and what diagnosis must be submitted. This is important since the primary diagnosis determines medical necessity.

• When verifying coverage for network and non-network facilities’ have the CPT, ICD-9 volume 3 code, or DRG available to understand coverage and limits.

• Most insurance plans require MRI services and surgeries are precertified, without this they will deny.

• If the information on the insurance website is not detailed, call the company directly. Educate your staff on the financial policies of the facility.

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