Internal Medicine billing and accounts receivable

Internal medicine carries the widest range of anything on this list — chronic disease, preventive care, procedures in the room — and the losses are spread thinly across all of it rather than concentrated.

Where the money leaks in internal 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.

• Preventive and problem-focused visits billed on the same day without modifier 25
• Chronic care management billed without documented time or consent
• Annual wellness visit and preventive physical treated as the same service
• In-office procedures bundled into the visit by payer edits
• Eligibility not verified, producing denials that were knowable before the patient arrived

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 internal 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-4 — Modifier and code disagree
  The code and the modifier disagree, or a modifier the payer required was not there.
  Recovered by being corrected and resubmitted. Matched from: “Preventive and problem-focused visits billed on the same day without modifier 25”
• CO-97 — Payment included in another service
  The payer is bundling this code into another one on the same claim. Sometimes that is correct and sometimes it is not.
  Recovered by being worked at the edit pair, with a modifier only where the record supports one. Matched from: “In-office procedures bundled into the visit by payer edits”

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

Questions