How to Prevent Shrinking Bottom-Line With A Streamlined Internal Medicine Billing Process

Streamlined Internal Medicine Billing Process

Many internal medicine practices in the US face the challenge of a shrinking bottom line, mainly due to the diverse aspects of the specialty—diagnostic, preventive, and curative. Due to this collaborative nature, the internal medicine billing process is particularly complex, where treatment episodes often involve coordination with various diagnostic laboratories and specialized care centers. This complexity underscores the importance of a streamlined approach to billing and revenue management, ensuring that all aspects of the treatment episode are accurately documented and billed for, thus minimizing the impact of shrinking revenues.

This provides financial challenges to internists as it leads to complications in billing and coding, especially as claims require joint coding of services and knowledge of the lab tests that are covered and ones that are not covered. Another source of the financial challenge that internists face is that the various health disorders internal medicine deals with involve multiple codes.

CPT Code for Internal Medicine

Here are some of the most commonly used Current Procedural Terminology (CPT) codes in internal medicine, based on their frequency and importance in clinical practice:

  1. 99214: Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes spent face-to-face with the patient and family.
  2. 99213: Office or other outpatient visit for evaluating and managing an established patient, typically 15 minutes spent face-to-face with the patient and family.
  3. 99215: Office or other outpatient visit for the evaluation and management of an established patient, typically 40 minutes spent face-to-face with the patient and family.
  4. 99204: This is an office or other outpatient visit for the evaluation and management of a new patient. It typically involves 45 minutes of face-to-face with the patient and family.
  5. 99203: This is an office or other outpatient visit for the evaluation and management of a new patient. It typically involves 30 minutes of face-to-face with the patient and family.
  6. 99212: Office or another outpatient visit for the evaluation and management of an established patient, typically 10 minutes spent face-to-face with the patient and family.
  7. 99307: Subsequent nursing facility care per day for the evaluation and management of a patient, which requires at least 15 minutes of the physician’s time.
  8. 99497: Advance care planning, including the explanation and discussion of advance directives, such as standard forms (with completion of such forms, when performed), by the physician or other qualified healthcare professional.

These codes cover a range of evaluation and management services and other standard procedures in internal medicine practices. The frequency of use can vary based on the specific patient population and practice setting.

The most commonly faced challenges include-

  • I accurately code peripheral tests and processes like injections, removal of skin tags, etc.
  • Keeping track of frequent changes to ICD-9-CM and CPT codes for numerous treatments included in internal medicine

 Frequent errors faced in claim preparation-

  • Selection of wrong codes
  • Use of generic protocol instead of patient-specific physician orders

The issues above also leave internal medicine physicians in a poor position to transition to ICD 10 by Oct. 2014. Experts say that an unsuccessful transition to ICD 10 will have a negative impact, mainly due to the regulatory changes brought on by the Affordable Care Act regarding reimbursement.

Hence, a successful transition is mandatory and will require analyzing current and past claims to identify billing coding and reimbursement risks related to the ICD 10 transition. Practices will also need to check their ICD 9 documentation for gaps because if there are coding errors in ICD 9, the prospect for a successful transition to ICD 10 is bleak. This document audit will help physicians spot what’s working and needs fixing.

Legacy AR - MBC

How to Prevent Shrinking Bottom-Line With A Streamlined Internal Medicine Billing Process emphasizes the importance of efficient billing practices in safeguarding financial health. By implementing a streamlined approach, internal medicine practices can effectively manage legacy AR (Accounts Receivable), ensuring timely reimbursement and reducing the risk of revenue loss due to unpaid claims. This proactive strategy optimizes cash flow and enhances overall operational efficiency, allowing healthcare providers to focus more on patient care and less on administrative challenges.

MBC’s Revenue Management Consulting services can help you with this by assessing your in-house revenue management cycle and ensuring sound coordination between various components of healthcare, facilitating a smooth flow of medical data. MBC also provides RCM services, which have enabled physicians to accurately document their medical services and related activities by using CPT and diagnostic codes correctly, investigating rejected claims, gleaning insights from them, and performing self-audits.

Medical Billers and Coders, the largest consortium of billers and coders in the US, has been helping several small to medium-sized internal medicine practitioners with its Outsourcing services, handling the entire range of activities involved in billing and coding so that they can solely concentrate on healthcare, even as they improve their finances. If you don’t need the entire suite of services, you can choose parts of MBC’s services that fit your billing and coding requirements, such as post-submission follow-up or only claim submission.

FAQs

  1. What is legacy AR, and why is it a concern for internal medicine practices?

    • Legacy AR refers to unpaid or outstanding claims that have accumulated over time. This can pose a significant financial challenge for internal medicine practices, leading to cash flow issues and reduced profitability. Managing legacy AR efficiently is crucial to prevent a shrinking bottom line.
  2. How does legacy AR affect the financial health of internal medicine practices?

    • Legacy AR impacts financial health by tying up resources that could be used for operational improvements or patient care. If not managed promptly, it can result in delayed reimbursements, increased administrative costs, and potential write-offs. Streamlining the billing process helps mitigate these risks.
  3. What strategies can internal medicine practices use to reduce legacy AR?

    • Effective strategies include implementing robust billing software to track and manage claims, conducting regular audits to identify unpaid accounts, optimizing coding and documentation practices to minimize denials, and establishing clear communication with patients about billing expectations. These efforts help improve cash flow and prevent revenue loss.
  4. Why is it essential for internal medicine practices to streamline their billing processes?

    • Streamlining the billing process ensures that claims are processed accurately and efficiently, reducing the likelihood of errors and denials that contribute to legacy AR. By adopting automated systems, practices can streamline workflows, improve collections, and enhance overall financial performance.
  5. How can outsourcing billing services help internal medicine practices manage legacy AR?

    • Outsourcing billing to specialized medical billing companies allows practices to leverage expertise and resources to manage AR effectively. These companies handle claims submissions, follow-ups, and patient billing inquiries, freeing internal staff to focus on patient care and practice growth initiatives. This approach often leads to faster reimbursement and reduced AR aging.