Hospitalist Medicine billing and accounts receivable

Hospitalist billing is inpatient E/M under time and medical decision making, and most of what goes wrong is two physicians billing the same patient on the same day.

Where the money leaks in hospitalist 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.

• Duplicate same-day E/M with another physician of the same specialty and group
• Admission and discharge on the same date billed as two services instead of one code
• Critical care time billed without the time and its content documented
• Observation versus inpatient status billed against what the hospital actually registered
• Consultation codes billed to a payer that no longer recognizes them

What a seat does about it

One trained person works your queue from the difficult end, from our office in Rawalpindi, Pakistan, logged into your own system on your hours. 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. Some payer contracts and some state Medicaid programs restrict or require disclosure of offshore access — check yours before placing a restricted queue on this seat (more on /security/).

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

The codes those turn into

Each of these is a denial code you are likely to meet working hospitalist 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-18 — Exact duplicate claim or service
  The payer already has this claim. Usually harmless, occasionally a sign that the original is stuck.
  Recovered by being checked against the original claim before any work is done. Matched from: “Duplicate same-day E/M with another physician of the same specialty and group”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and payers ultimately pay roughly 90% of claims even while using an initial denial to slow payment. Most of what sits in a hospitalist medicine AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions