Sample Letter: Getting to Know a Carrier's Surgical Billing Principles

Dear

It has been our experience that many insurance carriers apply various medical and payment policies in their processing of surgical claims.

We have searched your organization's Web site, and it appears this information is not posted.  In order to meet your organization's surgical claim processing requirements it would be helpful for us to know those policies for the following surgical billing components:

 

  • Global Surgical periods for both major and minor procedures.
  • Multiple surgery guidelines in terms of ranking procedures and prorated percentages for primary and secondary procedures.
  • Modifiers that are recognized and can be used for additional procedural explanation.
  • Office supplies that will be reimbursed for in-office surgery.

Your reply regarding these policies will help our practice accurately file claims to you. By knowing your billing requirements it should help eliminate unnecessary claim denials and request for additional information that are administratively costly and time consuming for both of us.

Sincerely,