The Internal Medicine Billing Errors That Drain Revenue Before Anyone Notices
Billing for internal medicine represents the core of the primary care and chronic disease revenue cycles, and is responsible for a patient population that is complex, chronic and thoroughly reliant on documentation to support the level of service provided. Internal medicine practitioners treat patients with multiple medical problems that must be cared for simultaneously, and this complexity needs to be reflected in the Internal Medicine Billing process. When a patient has visits for the management of hypertension, diabetes, and chronic kidney disease, it is not a straightforward visit. It requires multiple diagnosis codes, increased evaluation and management (E/M) code, and the documentation must reflect the decision-making process of the diagnosis and treatment of the patients.
Chronic Disease Management and Its Role in Internal Medicine Billing
An internal medicine population that is composed of patients with chronic disease breeds a dynamic set of care services that can be captured as ongoing care management (CCM) charges. Chronic care management services (CCM), principal care management (PCM), and transitional care management (TCM) are all Medicare-reimbursable when services provided and documentation meet specific criteria; but internal medicine billing staff not trained in the subtleties of the specialty often fail to use these billing codes. Every missed claim for CCM or PCM is missed opportunities for monthly revenue, and multiply in value to yield thousands of dollars each year for a practice with even a small Medicare caseload.
Time-Based Billing and Its Impact on Internal Medicine Revenue
The recent 2021 changes to Evaluation and Management (E&M) coding provided an opportunity for both a new foundation for selecting visit levels in internal medicine based on total provider time, including non-face-to-face time used for care coordination, documentation and review of the care plan on the day of service. This is a win win for internists because their encounters need to take longer time, but not unless their billers know how to accurately document that time. Continue to use element counting to select encounter levels, and your time will be undervalued.
Prior Authorization Management Within Internal Medicine Billing
Internal medicine offices generate many referrals, diagnostic imaging, and medications with long-term ongoing monitoring that requires special prior authorization testing, procedures, and medication management from commercial and managed care payer groups. Without prior authorization management included in internal medicine billing, authorizations are dropped, services are delivered in the absence of authorization, and claims are denied based on non-clinical details.
Dental Medical Billing: Navigating the Overlap Between Dental and Medical Coverage
Dental medical billing is unique among health services revenue cycles in that it deals with two different coverage systems. A large number of dental services can also be billed medically to a patient’s medical insurance, as long as care is provided to treat a patient’s medical condition and not to maintain or promote good oral health. Dental surgeries for trauma, treatment of oral symptoms of systemic disease and some maxillofacial surgeries are eligible for Dental Medical Billing through medical insurance.
Documentation Standards That Support Dental Medical Billing Claims
Dental medical billing through medical insurance requires clinical documentation that parallels medical billing practices, instead of dental charting practices. Medicare and other medical payers assess claims across ICD-10 codes for diagnosis, which demonstrate medical necessity, CPT codes for the service rendered, which provide the details of the service and the doctor’s notes, which explain the clinical reasoning behind the diagnosis and its treatment. Dental offices that try to pursue dental medical billing with the same dental documentation practices as their regular charting wind up with claims that are regularly denied, not because they are non-covered services but because the documentation is not in the vocabulary that medical payers will understand.
Coordinating Benefits Correctly in Dental Medical Billing
Dental medical billing is especially complex when it comes to the coordination of benefits (COB) between dental and medical insurance. In such circumstances, the correct order of billing, the determination of primary versus secondary payers, and handling of crossover claims all need to be handled carefully to ensure that the claims are not denied, overpaid or determining incorrect primary and secondary codes. Dental medical billing professionals familiar with COB regulations for dental, medical and pharmacy have the potential to secure maximum reimbursement for qualified encounters by making sure that both types of insurance are brought to bear on patient costs.
Specialist Billing Knowledge That Serves Every Encounter
Whether it’s internal medicine billing or dental medical billing, each type of medical billing requires special knowledge of specialty disciplines, the highest degree of accuracy in coding, and payer-specific information to produce different outcomes for the practice and patient. Med Brigade supports both types of practices in recovering the value of their care to contribute to their resource needs.