Internal Medicine Medical Billing and How Do Specialists Deal

Internal Medicine Billing Services in USA

by malikmoavia
What Is an Internal Medicine?

What Is an Internal Medicine?

A medical specialty that is associated with the diagnosis and medical treatment of adults is Internal Medicine. A specialized person in internal medicine is known as an internist. Below are the subspecialties of internal medicine.

  • Nephrology
  • Medical Oncology
  • Infectious Disease
  • Endocrinology
  • Adolescent Medicine
  • Gastroenterology
  • Critical Care Medicare
  • Sports Medicine
  • Interventional Cardiology
  • Rheumatology
  • Pulmonary Disease

Differentiate Between Internal Medicine and General Medicine 

In Internal Medicine physicians treat adults and they are specialized in diagnosing, preventing, and managing disease and chronic conditions. They’re well-trained to diagnose complex diseases occurring only in adults. On the other hand, general medicine physicians treat patients of any age, including children and adolescents.

Common Denials 

  • Hospice Denial

When a patient enrolls in hospice for treatment, Medicare HMOs will reject the claims as “Service Not Covered” because hospice patients are not covered by Medicare. In such a case, the patient’s hospice dates will be confirmed, and the patient’s eligibility will be reviewed online through Medicare. The GW modifier will be applied after it has been established that the patient has been registered in Hospice for the requested dates, and the claims will then be sent straight to Medicare.

  • Medical Records Denials

Humana insurance frequently rejects claims when medical records aren’t available. We use Availity to check the status of the claims online, and we fax the medical records to have the claims handled. Similarly, if the medical records are not in the EMR, we contact the facility and ask for them.

  • POS Denials

On superbills, doctors usually combine the observation code and the follow-up code. If the patient has been admitted to the hospital, it will be determined from the evaluation of the MR, and the necessary observation codes will then be invoiced under POS 22. If the patient has been admitted to the hospital, the POS 21 inpatient codes will be used for billing.

What Is an Internal Medicine Practitioner’s Role?

A wide range of care services and more than those offered by an internal medicine practitioner. In the event of an unknown illness, the patient always consults them first. Internal medicine medical billing services practitioners are not only limited to certain body systems, specific diseases, treatments, and procedures. Internists are associated with giving medicine for almost every disease and providing medical attention to so many medical issues. Also, sometimes even the patients who don’t have a particular complaint have one.

They have a range of tests and procedures to make an initial diagnosis and also provide routine preventative and periodic statements. Internists, rather than other specialists, are facing a lot of internal medicine billing service challenges. Internal medicine practitioners refer their patients to specialists for focused medical care and a proper check-up. This constant collaboration between multiple medical practitioners raises a lot of complexity in internal medicine billing services.

Challenges Faced by Internal Medicine Practitioners 

There are some regular changes in ICD-9-CM, CPT, HCPCS Level II, and modifier codes, further making the process of internal medicine billing services challenging. Furthermore, internal medical billers’ knowledge of coding is limited to a few specific treatments and procedures across a wide range of medical conditions and treatments.

Changes in the ancillary procedure codes like injections, vaccinations, and venipuncture, as well as the minor procedure codes for surgeries such as skin tag removals, joint surgeries, trigger point injections, etc.

Evaluation and management requirements for documentation standards and Medicare billing regulations.

Automation of processes and digitization of patient data can help to ease the internal medicine billing services process to some extent. Moreover, to improve profitability and reduce the administrative load of the internal medicine practice it is mandatory to implement practices that are efficient and productive in the long term. A variety of billing issues faced by internists can be resolved by adopting and applying the best billing practices used in the healthcare industry.

Ways in RCM Can Boost the Revenue of The Internal Medicine Practice 

  • Increasing the Rate of First-Pass Claim Resolution

Regular document inspection ensures fewer data entry errors and lowers the possibility of clearinghouse rejections. Documents filed with bill statements are reviewed regularly. Faster payments and an improved account settlement ratio follow from this.

  • Claim Denial Appeals 

By modifying your internal medicine billing services, you can improve your revenue. Simply by responding to the insurer’s inquiries about the documentation claims and submitting timely updated appeals.

  • Increasing Rate of Net Collection

In the coming months, Medicare and Medicaid will ensure a larger demographic of patients. They make it more challenging for the internists to ensure the collections. An increased net collection rate will be achieved by maintaining an effective submission procedure and following up on unpaid balances from both insurance and patients.

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