A Guide to Medical Billing for Hospitalists

Patient paying for medical services

Hospitalists are among the most critical healthcare providers for patients admitted for inpatient care. The hospitalist offers continuity of care for patients as they transfer within or across facilities and as they receive care from a range of specialists. This requires attention to detail for everything from taking a patient's history to managing the discharge process.

Managing care for patients is the primary priority for any hospitalist practice. However, the complexity of the hospitalist's role requires significant time and attention for administrative tasks such as coding, billing, and following up on outstanding claims. 

Revenue stream management is crucial for maintaining the financial health of your practice. Getting behind on billing-related tasks can result in missed claims deadlines, refused claims, and delayed payments.

Learning the intricacies of medical billing for hospitalists will help you understand the necessary steps for effective revenue stream management to maximize efficiency and ensure prompt payment.

Documentation

The core principle for medical billing is proper documentation. Clinicians need to note every aspect of care and provide that information when submitting billing claims. You need to ensure that you record patient history, diagnosis, treatment plan, and progress notes for the entirety of the patient's stay. Documentation must be complete and accurate and demonstrate that you provided all the services being billed.

Errors in patient information, such as a misspelled name or incorrect date of birth, can lead to claim denials and require that you resubmit with corrected information. Failure to sufficiently document services performed may prompt insurers to deny a claim entirely.

Appropriate Coding

It's imperative to correctly match medical services to their corresponding billing codes. Using incorrect Current Procedural Terminology (CPT) or International Classification of Diseases (ICD) codes can result in claims denials or downloading. This leads to denied or delayed reimbursement from insurers.

Clinicians can keep a list of the codes they use most often and refer to that when documenting care. In addition, clinicians and administrative staff need to stay informed of changes to coding protocols as well as coding for newly approved services.

Understanding Insurance Systems

Hospitals, particularly those with active emergency departments, see patients with all kinds of insurance coverage. Patients don't always have the luxury of choosing to get treatment at a hospital where the facility and a majority of outside clinicians are in-network. A hospitalist can expect to care for people with private insurance, Medicare, Medicaid, or a combination of insurance plans. Some patients may arrive without insurance coverage of any kind.

Hospitalist billing means dealing with multiple private insurers and navigating as both an in-network and out-of-network provider. Hospitalists also need to understand the procedure for billing under Medicare and Medicaid. Receiving payment for treating patients who do not have insurance or cannot pay for care may require working with the facility to receive payment under an arrangement for the care of the medically indigent.

Regulatory Changes

Medical care is subject to tremendous oversight. Oversight is necessary to ensure that patients receive safe, appropriate care for a reasonable and customary cost. It also means that rules regarding medical practice and billing are constantly changing.

One of the most common causes of revenue fluctuation is annual changes to Medicare reimbursements. Each year, the Center for Medicare and Medicaid Services (CMS) assesses the Medicare physician fee schedule (MPFS) and adjusts reimbursement rates according to relative value units (RVUs) of service and geographic cost indices. The new rates affect reimbursements beyond Medicare. Private insurance companies adjust their reimbursements to match CMS rates.

Anticipating and adapting to changes like this are necessary for managing revenue streams.

Using an Outside Billing Service

One way to simplify billing is to work with an outside billing service. Partnering with a reliable third-party billing firm can strengthen your practice's financial health and give you more time to focus on your patients.

PUREDI has over two decades of experience in revenue cycle management for hospitalist practices. In addition to coding and billing, we offer comprehensive practice management solutions, including analytics and reporting, credentialing, and electronic health record connectivity.

PUREDI can tailor services to your practice's individual needs. We provide 100% cloud-based intelligent software for medical billing and practice management services. Every client works with an account manager who is dedicated to the support of your practice. You can choose complete financial management services or select from a menu of services to develop the right plan to meet your goals and ensure that your practice thrives.

Contact us today to see how our customized services can optimize your revenue cycle and enhance your financial health.

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