Medical billing and coding services in USA
Ask any surgeon what a case looks like on paper and the answer is rarely one line. There’s the consult, the decision for surgery, the procedure, an assistant, maybe an implant, then ninety days of post-op care that is mostly bundled into the global fee. Put the wrong modifier on any of it and the payer bundles it or sends it back. That’s the work our surgical medical billing services take on at Evernest. We cover eligibility, authorization, coding, claims, appeals, and payments for surgeons and surgical groups, and we start by learning how your operating days and dictation run.
Picture your week. Monday is consults, and one of them turns into a decision for surgery. Tuesday and Thursday you operate. Friday you see post-op patients who are still inside the global period, and one who has to go back to the OR for a bleed. Every one of those is billed differently, and the answer to how lives in the operative report, the payer’s contract, and the fee schedule. Our surgical medical billing services check all three on each claim, so your staff isn’t fixing the same denial every month.
We bill the full episode from the initial consultation and the decision to go ahead with surgery through to the procedure and on through the post-op visits all within the global package. Our surgery billing team are absolutely familiar with what is bundled and what is not.
When a payer audits a surgical claim the operative report is the first thing they look at. We ensure that the procedure, diagnosis and modifiers on the claim are exactly what you dictated, line by line.
Authorization rules, NCCI edits and timely file limits all vary by payer and are changed more frequently than most practices are aware of. We track them contract by contract and apply them to each claim as they change.
No one should have to go to the office manager to find out what's unpaid. Our reports lay it all out in black and white: open claims, denials, aging and collections. Any company providing surgical medical billing services should be more than happy to provide you with the same. If a claim is stuck you can see exactly where it is and who it's with.
Surgical practices don’t usually lose money on one big claim. It’s a pile of small ones. A modifier 57 missing from the E/M the day before surgery. A staged procedure sent without modifier 58. A denial that sat for two months because nobody had time to appeal it. None of these looks like much alone. Over a quarter they do. Our surgical medical billing services go looking for them early, when they’re still easy to fix.
A specialized approach to surgical medical billing and revenue cycle management.
Multiple procedures, bilateral cases, assistants and co-surgeons all require their own modifier. Get the wrong one and your payment gets bundled or reduced.
A missing referring provider, the wrong place of service, a mistyped subscriber ID. Any one of those can park a claim for weeks and all of them are easy to pick up prior to submission.
Denials simply don't work. You've already earned the money and it sits outside your payment cycle (sometimes for months) until someone eventually comes along and takes it.
Elective surgery, advanced imaging and implants all typically require prior authorisation before the date of service. Submit the request without the clinical notes and anticipate it being returned as declined.
Surgical deductibles are high. We have clear estimates and statements and we follow up consistently to ensure patient balances don't just sit in the background.
Old claims need to be reviewed regularly and one person has to decide what the next step is. Otherwise they just sit there and become harder and harder to collect.
Give us the entire revenue cycle or just the bit that's causing the problem. Our surgical medical billing works both ways and nothing needs to be moved over all at once. We'd rather start at the point of pain.
Charge capture, coding and claim submission all built around your operative reports and tracked from the first charge entered right through to the final payment so nothing gets lost in the process.
CPT, ICD-10-CM and modifiers selected to match your operative report so the claim accurately reflects the work you performed.
Our surgery billing services team build each claim with the patient, provider, facility and coding details that the payer expect to see which in turn reduces the number of rejections that didn't need to occur.
We find out why a claim has been rejected, sort it out or appeal it and keep on with it until it's paid or we know why it's not going to be.
Coverage is verified prior to the date of service (including workers' comp, auto and liability details if the surgery is following an injury). That's far easier than trying to sort it out after a denial.
We submit the authorisation requests for surgery, imaging and implants with the clinical notes that the payer require in order to authorise them.
Unpaid balances and aged claims are reviewed on a regular basis so the older ones are dealt with rather than simply being forgotten.
Reports show you how billing is performing at the moment, rather than a summary which arrives weeks later and leaves you with even more questions than you started with.
Linking your operative reports, your diagnoses, your procedures and your billing rules.
One case can involve a consult, a decision for surgery, a primary procedure, an assistant, and an implant, and the operative report is where each of those is either supported or it isn’t. Coding it right means checking laterality, approach, extent of the work, the global period, and every modifier against what you wrote. Picking the closest code won’t do it. We treat surgical billing and coding as one process and review each of those points before a claim is released, which also protects you if a payer questions the case months later or during an audit. It also saves your staff from reworking the same claim twice.
Here's what happens to a claim when it gets to us. There's an owner at each stage and it's a hand off to the next one. Nothing sits in a pile waiting for you to have a quiet afternoon to look at it. That's how our surgery billing service should operate and that's the standard we operate by.
We'll confirm eligibility, coverage and authorisation prior to the date of service where we can and we'll take the workers' comp or auto details on the injury cases. That saves a massive number of phone calls down the line.
Surgical billing and coding are reviewed in tandem (procedures, modifiers, diagnoses and notes). The claim must reflect the case exactly, with nothing added and nothing omitted.
Claims go out once all the required fields have been checked. A missing field is a very frustrating reason for a rejection.
Every rejected claim or one that's stalled gets a next step, a deadline and one person assigned to it. They don't all end up in some general pile.
You see the open claims and outstanding balances as part of our surgical medical billing so you always know where the money is.
Tell us how you bill at the moment. We'll go through the workflow, ask you a few direct questions about your process and point out where some extra assistance could be of benefit. If we're not the right people for you then we'll be up front about that. This is not a sales pitch, it's just a discussion about what's working and what isn't.
Complete the form and our team will get in touch with you.
Nobody goes into surgery to read claim edits. Evernest provides surgery billing services that keep revenue moving when a claim hits a snag or a payer turns difficult. We work with surgical providers regularly, so staged cases and unplanned returns to the OR won’t be new to us.
Talk With Our TeamOur processes come from how surgical practices actually run, not from a generic billing checklist borrowed from another specialty. You’ll see the difference in your collections.
Our surgical medical billing services team reviews coding and documentation early, so small problems get fixed before they turn into bigger and costlier ones.
Open claims and rejections are worked on a set schedule, so nothing falls off the list or runs past a filing deadline, even on older accounts.
You can see what’s going on in your revenue cycle without chasing anyone for an update or waiting for month-end, and you always know who is handling your account.
Choose surgical medical billing services for one task or the full revenue cycle, whichever fits your practice today. If you add a surgeon, a second location, or a new service line later, the arrangement can grow with you.
Specialty-trained coders who know the modifiers, bundling rules, and payer quirks of your field.
Billing support for therapy evaluations, treatment sessions, rehabilitation services, and timed procedure codes.
Claims and coding support for laboratory testing, diagnostic services, and payer-specific billing requirements.
Specialty billing for urology evaluations, diagnostic procedures, treatments, and surgical services.
Emergency care coding and claims support for visit levels, procedures, and urgent diagnostic services.
Episode-based billing support for documentation, OASIS-related information, NOAs, claims, and A/R follow-up.
Billing and coding support for sports injuries, rehabilitation, musculoskeletal care, and related procedures.
Billing assistance for resident services, supporting documentation, claim accuracy, and account follow-up.
Specialty billing for endocrine evaluations, chronic condition management, diagnostic services, and follow-up care.
Claims and coding support for kidney care, renal evaluations, dialysis-related services, and chronic disease management.
Specialty coding for eye examinations, diagnostic testing, ophthalmic procedures, and surgical claims.
Billing support for vascular evaluations, diagnostic studies, interventions, and procedure-related claims.
Claims and coding support for speech, language, swallowing, and communication therapy services.
Durable medical equipment billing support for documentation, HCPCS coding, claim submission, and payer requirements.
Billing support for applied behavior analysis services, authorization tracking, session documentation, and claim follow-up.
Questions surgeons commonly ask about surgery billing, coding, claims, denials, and revenue cycle management.
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