Untapped potentials of Revenue cycle management in Internal Medicine
What is internal Medicine?
Internal medicine is a branch of medicine that focuses on adult medicine for prevention, diagnosis, and treatment of internal diseases, and nonsurgical treatment of diseases of the internal organs.
List down the subspecialties of Internal Medicine:
Cardiology, Endocrinology, Gastroenterology, Hematology, Infection diseases, Nephrology, Oncology, Pulmonary Disease, Rheumatology, Adolescent Medicine, Allergy and immunology, Critical care medicine, Geriatric medicine, Palliative care medicine, Neurocritical care, Sleep medicine, Sports medicine.
What are the responsibilities of an Internist?
Medical practitioners of internal medicine are called Internists. Their responsibility is to specialize in adult medicine and provide comprehensive, longitudinal patient care. Internists have a personalized approach to the analytical examination of laboratory science to help adults live healthily. They provide care to both hospitalized (inpatient) and ambulatory (Outpatient). In their role as Primary care physicians, they provide general medical care and diagnosis the infections, and diseases affecting the heart, blood, kidneys, joints, and digestive system. They help to manage chronic illnesses such as diabetes and asthma. Based on the needs Internists Consult and refer other specialists.
Why does the Internists need a revenue cycle management company?
Internists need revenue cycle management companies for their administrative support, such as front office work, Appointment scheduling to reimbursement.
List of administrative supports rendered by the Revenue Cycle Management Company:
The revenue cycle is a universal process across healthcare as it starts from patient appointments and ends when the practice receives payment for the services rendered. Revenue cycle management is split into three main functions:
1. Generate revenue:
Internist’s survival mainly depends on generating revenue. Generating revenue can be achieved by a proactive approach to appointment scheduling, capturing all necessary patient information, and collecting copays upfront. This will help a practice to optimize its revenue as well as reduce no-shows.
Appointment scheduling:
Appointments are fixed based on the provider availability and patient convenience without waiting.
Patient registration or Patient Demographics:
Demographics information – Patient’s legal name, age, gender, address, phone numbers, social security number
Medical Information – Special requirements, Allergies if any
Healthcare Insurance Information – Payer information (Primary, secondary, and additional plans is any)
Payment information – Information of the person who will be responsible for the payments.
Eligibility and Insurance verification:
The information payable benefits, co-pays, co-insurance, deductibles, patient policy status, effective date, type of plan and coverage details, plan exclusions, specific coverage, claims mailing address, referrals, and pre-authorizations, and lifetime maximum are the services included under eligibility verification.
2. Capture revenue:
Revenue capture begins with the clinical encounter of a patient with medical records management thoroughly recorded, accurate and complete documentation of services rendered. Precise coding based on documentation (CPT, ICD-10, Modifiers) helps to receive payment at the highest level.
Some Common ICD-10 Internal Medicine Diagnosis Codes for reference:
General Medical Examination:
Z00.00 – Encounter for a general adult medical exam without abnormal findings
Z00.01 – Encounter for a general adult medical exam with abnormal findings
Abdominal Pain:
R10.0 – Acute abdomen
R10.84 – Generalized abdominal pain
R10.9*- Unspecified abdominal pain
Back and Neck Pain:
M54.2 – Cervicalgia
M54.9*- Dorsalgia, unspecified
Acute Respiratory Infections:
J02.8 – Acute pharyngitis due to other specified organisms
J20.9*- Acute bronchitis, unspecified
Chest Pain:
R07.1 – Chest pain on breathing
R07.89 – Other chest pain
R07.9* – Chest pain, unspecified
Other Forms of Heart Disease:
I48.0 – Paroxysmal atrial fibrillation
N30.01 – Acute cystitis with hematuria
N30.31 – Trigonitis with hematuria
N39.0* – Urinary tract infection, site not specified
Pain in Joint:
M25.511 – Pain in the right shoulder
M79.605 – Pain in the left leg
M79.606* – Pain in leg, unspecified
Pain in Limb:
M79.609 – Pain in unspecified limb
M79.676* – Pain in unspecified toe(s)
E11.9 – Type 2 Diabetes Mellitus w/o Complications
R51 – Headache
Some Internal Medicine CPT Codes List for reference:
Evaluation & Management Procedures:
99202 – 99215: Office or other outpatient services,
99202 – 99205: New patient,
99211 – 99215: Established patient.
99221 – 99239: Hospital Inpatient and Observation Care Services
99242 – 99245: Office or Other Outpatient Consultations.
99252 – 99255: Inpatient or Observation Consultations
99304 – 99316: Nursing Facility Services
Pathology and Laboratory Procedures:
80047 – 80081: Organ or Disease Oriented Panels
85002 – 85999: Hematology and Coagulation Procedures
88000 – 88099: Anatomic Pathology Procedures
Radiology Procedures:
70010 – 76499: Diagnostic Radiology (Diagnostic Imaging) Procedures
77046 – 77067: Breast, Mammography
77071 – 77092: Bone/Joint Studies
3. Collect revenue:
Collection of revenue is associated with billing, Payment posting, and Accounts Receivable Management.
Provider Enrollment and Credentialing Services:
When a physician starts a new practice or joins a new one, switching from one physician practice group to another or enrolling with a new payor, Credentialing becomes mandatory. Insurance companies Medicare, Medicaid, and other commercial plans ensure proper credentialing to maintain high standards of safety in the healthcare profession for their enrollees.
Charge entry:
Enter medical billing details, claim scrubbing, claim submission, and verifying rejection with clearing house are the services included under charge Entry.
Payment posting:
Received insurance payments (ERA/EOB posting) are posted against claims, balance outstanding payment is billed either to secondary insurance or patient.
Accounts Receivable Management:
The outstanding payments that are due from patients, insurance companies, and other third-party payers for medical services provided for the patients are accounts receivable in medical billing. Patient billing, Denial Management, and appeals process are the services included under accounts receivable management.
Conclusion:
Internists or healthcare organizations are confronting a perfect storm of clinical and financial issues as several regulatory initiatives collide with an existing need for faster billing cycles and cost containment. To mandate faster billing cycles, evaluate what methods can be implemented to receive the most benefits, employ the most intelligent automated technology, to improve the patient experience, healthcare organizations and practices are forced to have the best Revenue Cycle management company tie-up. AnnexMed can be your best choice RCM company with vast experience as revenue specialists and Certified coders.