Medical billing for specialists and surgeons

Billing built around theatre and specialist work

Specialist and surgical accounts are more involved than a consulting-room bill. A single procedure can involve the surgeon, an assistant and an anaesthetist, a pre-authorisation, ICD-10 and procedure codes with modifiers, and a scheme rate that may differ from what you charge. Forte Medical handles this billing for specialist and surgical practices, on whichever major practice management and billing system suits the practice.

Fees are quoted per practice, as a percentage of what is actually collected, with no hidden costs and no annual increases.

What we do for your practice

Theatre and procedure coding

We capture theatre and procedure accounts from your theatre lists and notes, and check the procedure codes, ICD-10 codes and tariff modifiers before submission, so the claim matches the work you did and the scheme's rules.

ICD-10 codes and tariff modifiers

We check that each claim carries the right ICD-10 diagnosis codes and the modifiers that apply, for example for assistants, multiple procedures or time-based units, and we keep scheme tariffs up to date.

Assistants and anaesthetists

Where a case involves an assisting surgeon or an anaesthetist, we coordinate with their rooms or billing offices on case details and codes, so the accounts for the same procedure line up.

Pre-authorisations

We help your rooms obtain and record pre-authorisation numbers for planned procedures and link them to the claim, and we follow up when a scheme's authorisation does not match the procedure performed.

Prescribed Minimum Benefits (PMBs)

For conditions that qualify as PMBs, we submit the claim with the supporting codes and information the scheme needs, and follow up with the scheme where a PMB claim is short-paid or paid from savings.

Gap cover

Where you charge above the scheme rate, we prepare the statements and documents patients need to claim the shortfall from their gap cover insurer.

Hospital case managers

We liaise with hospital and scheme case managers on authorisations, length of stay and additional procedures, so the account reflects what was approved.

Medical aid rejection follow-up

When a scheme rejects or short-pays a claim, we look at the reason, correct and resubmit where the claim is valid, and keep a record of every follow-up.

Debtor management

We send patient statements, follow up outstanding patient portions and medical aid balances, and handle account queries from your patients.

Monthly reporting

Each month you receive reports showing what was billed, what was paid by schemes and patients, and what is still outstanding.

Your system or ours

We work with all major practice management and billing systems. If your practice already uses one, we can work in it, so your data stays in a system you know. If you are starting out or want to change, we can advise on the options and set your practice up.

• Focused on specialist and surgical practices
• We work with all major practice management and billing systems
• Based in Randburg, Johannesburg, established in 2008
• Fees quoted per practice, as a percentage of what is actually collected

Moving from another bureau?

Read how switching your billing to Forte works, step by step.