Managing Reimbursement in Private Practices

Managing Reimbursement in Private Practices

Managing Reimbursement in Private Practices – the CCSD Schedule.

There are numerous considerations to be assessed before setting up a private practice. On top of a whole host of administrative, financial and legal implications, doctors must also address the CCSD Schedule.

The Clinical Coding and Schedule Development Group supports the development of standard codes for medical procedures and diagnostic tests in the UK independent healthcare sector. These coding principles and guidelines apply to individual insurers and healthcare providers – enabling the accurate coding of clinical activity in private medical practices. By implementing industry standard codes across the sector, doctors and insurers gain from a transparent reimbursement policy.

CCSD Codes Explained.

Each surgical and medical procedure has a unique code and description – this is the CCSD code. Healthcare insurers use these codes to determine the payment for a particular treatment.

While CCSD codes are used by all insurers, the associated fees are set by each individual provider. These fees are based on varying factors – such as the complexity, duration and research involved in each treatment – as well as specialist charges. And as procedures may change over time, CCSD codes are always under review, and are intended as a guideline only.

The importance of CCSD Codes in Private Practices.

Monitoring CCSD codes is vital to the prosperity of your private practice. Specialist procedures represent a significant segment of your business – and a large proportion of your patients pay for their treatment through healthcare insurance policies. Therefore, a huge percentage of your invoices will be calculated and remunerated according to their relevant CCSD codes.

Many factors affect the level of reimbursement your consultants receive, including:

  1. Multiple procedures

Most insurers pay 100% of the fee for a single procedure – according to its CCSD code and subsequent complications. When multiple procedures are performed, insurers may only cover a smaller percentage. And bilateral procedures performed during the same operative session may also have varying coverage.

  1. Specialist charges

Pain relief, pre-operative assessments, general or regional anaesthetic and multiple consultations may be considered as specialist charges by some insurers.

  1. Complications

The listed reimbursement fee for the principal procedure covers most common complications – such as bleeding, infection management, the provision of IV fluids,the  removal of sutures, post-operative assessments and simple wound care. If patients have to return to the theatre due to complications, the subsequent treatment may not be covered in the initial reimbursement fee.

  1. Critical Care

Insurance providers usually cover critical care following an elected, pre-authorised procedure in the initial reimbursement fee. Otherwise, it may be covered added as an additional charge.

While managing the CCSD codes – and how insurers interpret them – may seem complex, there is a simple solution. Implementing a private practice management solution – like PPM Software – streamlines the entire payment process. The CCSD schedule is pre-loaded in the system, and the relevant code is included on each invoice – as well as a description of the procedure and the amount you’re billing for.

With PPM Software, you can customise additional charges and procedure codes – as well as set-up multiple fee tables for insurance companies and self-pay patients. Any further treatments can be entered and subsequently called-up in just a few clicks – either on your network or remotely. It also allows complication details and outcome data to be easily recorded for analysis.

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