Geriatric Medicine billing and accounts receivable

Geriatrics carries chronic care management, annual wellness visits, advance care planning and transitional care — services with real revenue and unusually specific documentation and timing rules.

Where the money leaks in geriatric medicine

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Chronic care management billed without the documented time or the required consent
• Annual wellness visit billed as a preventive physical, which is a different and often uncovered service
• Transitional care management billed outside the contact and visit timing windows
• Advance care planning time not documented, so the add-on is denied
• Place of service wrong for nursing facility or assisted living encounters

What a seat does about it

One trained person works your queue from the difficult end. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing.

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and certified coding at $2,500.

The codes those turn into

Each of these is a denial code you are likely to meet working geriatric medicine, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-16 — Claim lacks information
  Something on the claim is missing or malformed. On its own the code tells you nothing — the detail is in the remark code that comes with it.
  Recovered by being corrected and resubmitted. Matched from: “Place of service wrong for nursing facility or assisted living encounters”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and about about 90% of initially denied claims are eventually paid. Most of what sits in a geriatric medicine AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions