23 Aug Manage Profit Better with Hospitalist Medical Billing
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Unless the billing for a Hospitalist practice is handled by staff who know how to navigate the exacting standards of coding, compliance, and insurance payment management, it doesn’t bode well for a healthy bottom line.
But the challenges of Hospitalist billing are as significant as the specialty:
Multiple Billing Codes to Keep Track Of
On any given day, or even within a single shift, a hospitalist might see patients with a variety of health insurance coverage: Medicare, private insurance, or no insurance coverage. Each of these will have dedicated billing codes, forms, and billing processes.
…and the Codes Change a Lot
In the grand timeline of healthcare, Hospital-Based Medicine is a relatively new specialty. This translates into more frequent legislative adjustments than would be found in other areas of medicine.
A recent example: as of January 1, 2023, changes to the Hospital Medicine E/M Codes included: the elimination of observation codes, revisions made to inpatient codes, changes in how to bill and document visits, and adjustments to wRVUs.
Beyond the codes themselves, there are even more legal measures that hospitalists must be aware of in order to remain in compliance.
Available Billing and Coding Resources: Not Always
Not every hospital billing and coding department includes Hospitalist work. So either a practice must have its own billing team or the individual hospitalist must handle the mountain of paperwork.
Billing and Coding: Inpatient Services vs. Outpatient Services
Different code sets and guidelines are used for services performed in an outpatient setting, as opposed to those delivered in an inpatient setting. These services are also paid differently. If the codes aren’t accurate, the claim will most likely be denied.
After the Coding Challenge: the Reimbursement Maze
According to the American Hospital Association (AHA), hospitals typically deal with more than 1,300 insurers. Just like the inpatient vs. outpatient challenge, each insurer has different plans, and multiple requirements for hospital billing.
Payment rates at private insurance company can vary widely. Medicare may have created uniform premiums and deductibles, but the benefits are determined by the beneficiary State of residence; and those states determine how the monies are paid. Hospitals also provide certain uncompensated services. Added to that, government regulations make hospital billing even more complex.
Meeting Hospitalist Billing Challenges with
Expertise, Experience, and Partnership
The decision to outsource Hospitalist billing is a good first step, but which outsourcing company? The complexity and unique nature of Hospitalist billing requires powerful systems, but also systems that are flexible and integrate with the software a practice already has in use.
There’s still more to consider because powerful systems are only half the equation.They must be combined with professional-grade, experienced Hospitalist billers and coders, a team dedicated to each practice, that works in its time zone, and is available for hands-on support whenever they’re needed.
Medusind: the Definition of Hospitalist Outsourcing Partnership
Successfully navigating every aspect of billing for Hospitalist practices nationwide, Medusind delivers industry-leading technology, combined with exceptional expertise, experience, and commitment, to become a trusted partner and a recognized prescription for a Hospitalist’s healthy bottom line.