Current Role of Surgical Assistants in Surgery

A Surgical Assistant is a qualified licensed individual who is a vital member of an operating room team with a variety of tasks before, during, and after surgery. Their main objective is to help the surgeon to carry out a safe operation while achieving the best results for the patient. Surgical assistants are also very skilled at working both independently and in a team environment

Laws governing Surgical Assistant's scope of practice and extensive training procedure in United States

Surgical Assistants first must go through extensive education and training as well as meet legal requirements before they can receive certification. Once they have graduated, then they will be eligible to take the exam to become a Certified Surgical Assistant. In Texas, Surgical assistants must meet multiple licensure requirements. These include a minimum of 2000+ hours of experience in the operating room assisting during past three years to officially posses a Certified Surgical Assistant credential. Throughout their careers, there is continued medical education as well as license renewal, so they stay up to date on modern medicine and state laws.

How insurance companies are treating Surgical Assistant's claims if they are independently billing for themselves through a third party biller

Surgical Assistants operate typically under out-of-network providers practice model. Surgical Assistants are historically not recognized by CMS (Medicare) and hence do not get paid on government cases. Insurance carriers treat surgical assistant claims according to the insured member’s contract which determines the actual payment to the Surgical Assistant providers. Physician Assistants (PAs) are different from Surgical Assistant providers as they are recognized by CMS and likely get paid for everything they do with the fact that PAs can not work independently per CMS rules and guidelines. Additionally, PAs must be employed by a group of providers, hospitals/facilities or physicians directly.

New laws governing out-of-network providers poses threats to filed claims.
Surprize Billing Act spares no one, it's the fine print that matters.
Restrictions as to what can be billed and how much, is being enforced by Federal Bill.
Members must consent to bill for surgery for Surgical/Physician Assistant's participation.
Reimbursements being calculated based fair-health benchmark & geographic locations.

Facts & Figures

Looking for a credible surgical assistant billing company to remotely work for you in full compliance with the laws governing the industry and to meet your expectations at the same time?

Different insurance carriers have different criteria to handle small versus large volume of out-of-network claims.

Certain selected payor mix with selected geographic zip code determines the level of reimbursement.

Federal Surprise billing Act effective January 1st 2022 mandates patients to acknowledge the participation of Surgical Assistant provider.

How does State of Texas bill SB 1264 is different from Federal Surprise Billing Act? How different policies are affected by these bills.

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