Integrative and Functional Medicine billing and accounts receivable

These practices mix covered medical services with services no plan covers, and the commonest failure is billing the two the same way — which is both a denial and a compliance exposure.

Where the money leaks in integrative and functional 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.

• Non-covered services billed to insurance rather than collected as cash
• Advance beneficiary notice or private-pay agreement not obtained before a non-covered service
• Extended visits billed by time without the time documented
• Supplements and infusions billed under codes that do not describe what was given
• Patient balances misstated because covered and cash services were mixed on one statement

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.

Questions