Infectious Disease billing and accounts receivable

Infectious disease is consultation-heavy and drug-heavy: long courses of expensive therapy, each carrying its own authorization and its own reauthorisation nobody is counting.

Where the money leaks in infectious disease

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.

• Specialty drug authorization lapsing mid-course, so later infusions deny
• Outpatient parenteral antibiotic therapy denied for home infusion coverage rules
• Consultation codes billed to payers that require an office or inpatient E/M instead
• Time-based prolonged services billed without the time documented
• Testing denied for a diagnosis outside the coverage policy's list

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 infectious disease, 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-167 — Diagnosis is not covered
  The payer does not cover the condition you billed, whatever the procedure was.
  Recovered by being appealed with clinical documentation. Matched from: “Testing denied for a diagnosis outside the coverage policy's list”

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 infectious disease AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions