Key medical billing and coding considerations for hospitalistsKey Medical Billing and Coding Conside

Key Medical Billing and Coding Considerations for Hospitalists

Outsourcing medical billing to an experienced service provider is a practical strategy for hospitalists to negotiate the reimbursement maze.

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Phone: 1-800-670-2809

Hospital medicine is the fastest growing medical specialty in the U.S., with more than 48,000 practitioners working as hospitalists. A hospitalist may work only in a hospital, only in a post-acute care (PAC) setting, or in both types of facilities.

Hospitalists face many medical billing and coding complexities that can lead to reimbursement issues. In 2016, Centers for Medicare & Medicaid Services (CMS) approved a dedicated specialty billing code for hospitalists. With the shift from fee-for-service to quality-based payment models, this code is aimed at ensuring that hospitalists are revaluated fairly and reimbursed correctly. Here are some key billing and coding considerations for hospitalists: ďƒ˜ Different payers and payment models: As there are a variety of payers and payment models, hospitalists must follow the billing rules of each payer when submitting claims for reimbursement. Most post-acute care patients, especially those less than 65 years old, are covered by private insurance companies. Medicare and Medicaid are the primary payers for those aged 65 and older. With the focus on value-based care and bundled payments, payers are using various criteria to assess providers that participate in these arrangements.

According to a recent report in The Hospitalist, these criteria include length of stay, cost, readmissions to hospitals, and quality. For instance, Medicare implements payment adjustments for hospitals that have high rates of readmissions. ďƒ˜ Need for more detailed documentation under ICD-10: As ICD-10 has brought greater specificity in coding, hospitalists need to be aware of documentation opportunities. Knowing when and how to provide detailed documentation will help to accurately describe severity of illnesses, complexity and quality of care, and overall resource utilization.

Experienced coders in physician coding companies can help hospitalists take advantage of important ICD-10diagnostic opportunities such as documentation of coma, coma score, and coma scale components, the distinction between hypoxemic and hypercapnic respiratory failure, and identification of osteoporotic fractures.

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 Comprehensive documentation of the initial hospital visit: There are three important components in the documentation of the initial hospital visit: history, physical examination, and medical decision-making.

In order to avoid down-coding, the physician should ensure complete documentation of systems and histories, including the patient’s family history.

 Coding for the subsequent hospital care (CPT 99231–99233): This is one of the most complicated areas of hospitalist billing and errors can lead to denials, downcoding, and lost revenue. When billing for subsequent hospital care, providers should take care to choose the appropriate level of service based on the patient’s condition and provide appropriate documentation to reflect and support chosen code. When it comes to follow-up, specific documentation of the visit is crucial to avoid triggering a denial for medical necessity.

A physician can bill only one subsequent visit per day when many providers in the group are involved in the patient’s care. The subsequent visit bill for any given date should include all the services rendered by providers within the same specialty group. The code assigned should reflect the level of all the work provided by all the physicians in the group.

With changing billing regulations and payer requirements, complex CPT and ICD coding, and rules on modifier use, outsourcing medical billing and coding is a practical option for hospitalists. The team in a reliable outsourcing company will work with their clients to ensure accurate coding and billing as well as documentation that reflects services provided. Such services go a long way when it

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Outsource Strategies International 8596 E. 101st Street, Suite H Tulsa, OK 74133

www.outsourcestrategies.com

Phone: 1-800-670-2809