A Stronger Revenue Cycle for ENT’s Busiest Season

Every winter, flu fills ENT clinic schedules with sick visits and pushes elective surgery back, sometimes past January 1. That timing barely changes from year to year, so whether it turns into a cash problem comes down to whether the revenue cycle keeps up with the schedule.

Same-day scopes need notes that hold up to modifier 25 review. A rescheduled surgery can slip outside its authorization window, and a case pushed into January runs into a new plan year. Meanwhile, claims and denials still need working when half the billing office is home sick. November gives the team time to address those gaps before the winter peak.

CDC surveillance puts the peak of U.S. flu activity between December and February in most seasons, and February has been the most common peak month across four decades of data (CDC).

CDC lists sinus and ear infections among the moderate complications of flu (CDC), so a heavy season can bring more of those complaints to ENT.

Illness also disrupts the OR schedule as patients postpone sinus procedures and children booked for tonsillectomy or ear tubes are held back for weeks. A review of anesthesia in children with a recent upper respiratory infection found that the risk of complications drops significantly when surgery waits two to four weeks after symptoms resolve (Pediatric Reports, 2025). A case cancelled in mid-December can easily land in late January.

The billing team is left supporting more clinic visits while keeping approvals and coverage checks current for surgeries whose dates are still moving.

Each change in the schedule adds work for the billing team. The diagram connects those changes to the affected workflows and the risks when work falls behind.

When symptoms persist, your providers may perform a diagnostic scope the same day to find the cause before deciding on treatment. These scopes include nasal endoscopy and flexible laryngoscopy.

Medicare puts diagnostic nasal endoscopy and flexible laryngoscopy in its 0-day global surgery category. The procedure payment includes a same-day visit by the same provider, along with the evaluation that leads to the scope (CMS Global Surgery booklet, p. 6). In a multi-site group, "the same provider" reaches further than one physician. Providers in the same group with the same specialty bill as though they were a single physician, so a same-day visit with another ENT in the group falls under the same rule. A same-day evaluation and management (E/M) visit is separately billable with modifier 25 only when the patient's condition required a significant, separately identifiable E/M service beyond the usual pre- and post-procedure care. The visit and the scope can share a diagnosis, but the medical record must document both services well enough to support the claim.

That standard is harder to meet when providers add patients to full schedules and leave charting until the end of the day. When notes fall short of what modifier 25 requires, the same gap can repeat across every site until someone spots the pattern in the denials.

A postponed surgery delays revenue, and the new date can put the claim at risk. Payers such as Point32Health require prior authorization for endoscopic sinus surgery (Point32Health guidelines), and each approval covers a set date range. A case authorized in October and rescheduled twice can fall outside that range, leaving the claim open to denial as unauthorized.

A new date can also mean a new plan year. A patient who changes employer coverage or Medicare Advantage plans on January 1 brings new eligibility and authorization rules to a case that was cleared under the old ones.

Postponed cases land just as patient deductibles start over. The Medicare Part B deductible applies once per calendar year (CMS MLN Matters MM14279), and calendar-year commercial plans also reset January 1. A sinus surgery the plan would have paid mostly in December can leave a larger balance with the patient in January, which slows collection.

Submitting claims daily and working denials within days helps keep collections on schedule as clinic volume rises. During flu season, sustaining that pace means arranging coverage for billing staff who may be out sick themselves.

Coding queues that back up in December can come back as denials in February, and a Q1 dip in collections may trace back to work that slipped weeks earlier.

In its CY 2027 Physician Fee Schedule proposed rule, CMS proposes reducing payment when the same physician, or another physician in the same practice, bills a separately identifiable office E/M visit on the same day as a procedure with a global period (CMS fact sheet). For ENT groups, that covers the same-day visit and scope described above. The proposal would pay the second, lower-priced same-day service, usually the visit, at 50% of its usual rate. AAO-HNS has lobbied against the proposal.

Use November and December to review documentation, confirm approvals on rescheduled cases, and arrange billing coverage before flu activity peaks. The goal is to enter January with cases ready to bill rather than a backlog of unresolved questions.

• Check same-day visit notesSample visits where a provider billed a visit and a scope on the same day. Check each note documents a significant, separately identifiable visit, not just the usual pre-procedure assessment.Protects: Same-day visits from denialTiming: Before December
• Log approval dates for surgeriesRecord when each surgery’s authorization expires. If a case is rescheduled, check the new date still falls inside it, or request a new approval.Protects: Postponed cases from denialTiming: Each time a case moves
• Re-verify cases moved into JanuaryConfirm the patient’s plan and authorization rules for the new year, and estimate their share now that deductibles have reset.Protects: January cases from denialTiming: Before each January surgery
• Plan billing cover for the peakDecide now who submits claims and works denials when billing staff are out sick, so claims still go out daily.Protects: Steady cash flow through the peakTiming: Before December