In the United States hospital, medicine is one of the rapidly expanding specialties, with 50,000 plus hospitalists. A hospitalist can work in both post-acute care (PAC) as well as in hospitals. As far as hospitalized patients are concerned, medical coding is quite difficult for them owing to their critical conditions. One the other hand, it is simpler for those who are cared for by practitioners in different specialties like outpatients.
The Centers for Medicare & Medicaid Services (CMS) approved a new dedicated billing code for hospitalists which is a significant step in the acknowledgment of hospital medicine. This code is focused on assuring hospitals are fairly reimbursed and revaluated as it has been observed a transformation of payment model from fee-for-service to quality-based.
Following are some of the key points for coding and billing for hospitals, without wasting much time let us jump on to the points:
Complete documentation of the first visit to the hospital
There are about three significant elements in the documentation of the initial hospital visit. The elements are medical-decision-making, physical examination, and history. To bypass down-coding the physician should make sure thorough documentation of histories and systems like a family history of patients and others.
Different payment models and payers
While submitting claims for reimbursement, hospitals should follow the billing guidelines given by payers. As there are multiple payers with different payment models. Post-acute care patients that are below 65 years are covered by private payers. Providers who are engaged in these agreements are analyzed by payers using different criteria. Moreover, payers focused on bundled payments and value-based care. The different criteria include cost, quality, duration of stay, readmission, and others.
Coding for the corresponding hospital treatment (CPT 99231–99233)
It is one of the most complex aspects of hospitalist billing and errors that can result in down coding, denials, add loss of revenue. When it comes to billing for corresponding hospital treatment, providers should be careful in order to select the proper level of service depending on the condition of the patient and offer correct documentation to showcase and support the selected code. As far as follow-up is concerned, certain documentation of visits is critical in order to escape boosting a denial for medical requirements.
A physician can bill only one corresponding visit each day when the patient is engaged in the treatment of multiple providers within the community. The corresponding visit bill for the given date should contain all the services offered by providers in the specialty group. The assigned code should represent the level of almost all of the work that all doctors in the community do.
Outsourcing medical billing and coding is one of the practical alternatives for providers as billing regulations are changing. Furthermore, payer requirements, rules, modifier use, and critical ICD and CPT coding are also changing. The trustworthy billing and coding organization will function with their clients to make sure correct billing and coding and documentation, which showcase offered services.
Thorough Documentation under ICD-10
Precision in coding had been bought by ICD-10 and hospitals require to be mindful of documentation opportunities. Understanding the procedure and time to offer thorough documentation will help in order to elaborate intensity of illness, utilization of resources, and quality and complexity of treatment.