Case Study: Recovering $120K by Fixing Coding Errors in Plastic Surgery Billing

When a high-volume plastic surgery clinic in Chicago noticed a growing gap between expected and actual collections, they suspected their billing process was falling short. Revenue was leaking, claims were being denied, and payments were delayed—all without a clear cause.

That’s when they brought in MBW RCM, specialists in plastic surgery billing services. Within just 90 days, we helped them recover over $120,000 in lost revenue, reduce claim denials, and streamline their entire billing workflow.

Clinic Profile

• Location: Chicago, Illinois

• Specialty: Plastic and Cosmetic Surgery

• Monthly Patients: ~180

• Monthly Revenue Volume: $350,000

• Monthly Collections (before): $245,000
  

Despite steady patient volume and high-value procedures, the clinic’s revenue cycle was underperforming. Most of the financial shortfall stemmed from coding errors, authorization delays, and poor claim follow-up—issues that are all too common in plastic surgery practices.

The Key Challenges

1. Complex Procedure Coding

   From cosmetic surgeries to reconstructive procedures, plastic surgery coding is intricate. Mistakes in CPT or ICD-10 codes were leading to frequent rejections.

2. High Denial Rates

   Claims were often denied due to mismatched documentation, missing modifiers, or not meeting payer-specific requirements.

3. Delays in Authorization and Insurance Verification

   Manual processes slowed everything down. Pre-approvals weren’t always secured in time, leading to delayed or denied claims.

4. Underpayments & Delayed Reimbursements

   Payments were either short or late, putting pressure on cash flow and financial planning.

5. Patient Collections

   Cosmetic procedures often involved out-of-pocket payments, but without a streamlined system, collecting from patients was inefficient and time-consuming.

Our Strategy

MBW RCM performed a full coding and billing audit to pinpoint where money was slipping through the cracks. Then we implemented targeted solutions to address each problem:

Problem	What We Did
Incorrect Coding	Our certified coders reviewed and corrected CPT/ICD-10 codes based on clinical documentation and payer rules. This drastically cut errors.
Frequent Denials	We introduced real-time claim validation tools and held focused training sessions with staff to improve submission accuracy.
Authorization Delays	A live tracker and instant insurance eligibility checks were implemented, reducing approval delays before procedures.
Late Payments & Underpayments	We began following up on unpaid claims starting Day 15 and introduced escalation workflows to resolve payer issues faster.
Patient Billing Issues	Rolled out an automated portal with flexible payment plans, making it easier for patients to pay and for staff to track balances.

Results: What Changed in Just 3 Months

• Recovered $120,000+ in denied claims over 6 months

• Claim denials dropped by 38%

• Reimbursement times improved by 27 days

• Billing delays reduced by 40%

• Monthly collections rose by 15%

These improvements didn’t just boost the bottom line—they freed up the clinic’s team to focus on delivering excellent patient care, not fighting with insurance companies.

Conclusion

For this Chicago-based plastic surgery clinic, the difference was night and day. By addressing coding errors, improving payer communication, and modernizing their billing systems, they regained control of their revenue cycle.

At MBW RCM, we understand the unique billing challenges of plastic surgery practices—from complex procedure coding to out-of-pocket patient payments. Our expert team delivered real financial results, fast.

Is Coding Errors Draining Your Practice Revenue?

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👉 Get a Plastic Surgery Billing consultation today