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| Home » Healthcare Case Studies |
Healthcare Case Studies |
| Hospitalist Billing – Critical Issues |
| Hospitalist frequently bills Medicare and other payers for providing subsequent hospital care to patients during their hospital stays. Incidentally, subsequent hospital care tops the list of coding problems that the Centers for Medicare & Medicaid Services (CMS) identifies in its Comprehensive Error Rate Testing program and Hospital Payment Monitoring Program |
| Picking the wrong code: |
One of the most common mistakes hospitalists make is billing for a higher level of subsequent visit than the documentation and service can support. Infintie BPO bill the highest level - 99233 - only for patients with a deteriorating condition, backed up by physician diagnosis and documentation. Infinite BPO highly educated coding team ensures that all the codes and updated are in line with CMS billing guidelines. |
| “Clustering” subsequent visit codes: |
Another big mistake is using the wrong billing pattern. Billing highest level 3 (99233) visits in a row followed the next day by a discharge code, for example, could set hospital up for an audit. Infinte BPO help hospitalists identifying the commomn mistakes and consistently monitors the billing process. |
| Skimping on history documentation: |
At each and every visit, Physicians must state the reason why they are seeing the patient and the reason for the service to establish medical necessity. Infinite BPO educate hospitalists on these relevant issues that directly effects the timely payment of claim.
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| Case Example: |
| Day 1 |
Admission |
99223 |
Patient presents with Hypertension, CHF, pneumonia, high complexity |
| Day 2 |
Subsequent Visit |
99232 |
Patient Stable and improving, lowgrade fever |
| Day 3 |
Subsequent Visit |
99233 |
Hypertension becomes uncontrolled |
| Day 4 |
Subsequent Visit |
99232 |
Hypertension controlled, fever gone, pneumonia improving |
| Day 5 |
Subsequent Visit |
99231 |
Patient Stable and improving, no new complaints |
| Day 6 |
Discharge Services |
99238 |
MC spent less than 30 mins preparing discharge order |
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| Ignoring daily concurrent care: |
Concurrent care becomes a real medical necessity issue, especially when several physicians are rounding on the same patients. Even if the physicians in the group bill more than one subsequent visit each day, only one subsequent visit bill will be paid. Infintie BPO keeps a check on these issues on daily basis, keeping an eye on every detail.
Infintie BPO highly trained billers make sure that subsequent visit bill for any given date includes all the services rendered by providers of the same specialty within the group. They combine all visits during one calendar day and select the code that reflects the level of all the work provided. |
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