What Is Internal Medicine Billing?

Internal medicine is a critical aspect of every healthcare institution. It is a wide specialty that has the potential to generate a big revenue. For that, your healthcare facility must have an excellent internal medicine billing team. But what is internal medicine billing and why is it so important for all healthcare facilities offering such services?

Understanding the internal medicine billing process is crucial for financial stability, practice success, regulatory compliance, and building patient trust and satisfaction. Consequently, internal medicine billing is fundamental for adequate compensation and revenue optimization.

What Is Internal Medicine Billing?

Internal medicine billing is the process of invoicing, managing, accurately documenting, and submitting claims for the services provided by internists to insurance companies. Internal medicine billing is essential in the healthcare revenue cycle, as it guarantees that practitioners receive payment for the services they provide.

To add to it, internal medicine is a specific branch that focuses on preventing, diagnosing, and treating a wide range of adult diseases. Internists, or physicians specializing in internal medicine, are trained to manage patients with complex and chronic illnesses as well as those with multiple health issues. While they primarily treat adults, they address both serious and less severe conditions, providing comprehensive care for a variety of health concerns. More specifically, it deals with medical conditions that can be either acute or chronic, such as: 

  • Allergy 
  • Cardiology
  • Hematology
  • Gastroenterology
  • Diabetes
  • Sclerosis or Parkinson’s disease 
  • Arthritis

Internal medicine vs general medicine

While internal and general medicine are two terms sometimes used interchangeably, both have distinct differences in the medical field. The main distinction between general medicine vs internal medicine is that the former specializes in the diagnosis, and treatment of individuals of all ages, while the latter primarily treats complex illnesses mostly predominant in adults.

Key Components of Internal Medicine Billing

Internal medicine billing is a complex process of translating internalists’ services into medical codes and submitting medical claims. For a seamless and timely reimbursement, the key steps that must be followed are:

Patient registration

The internal medicine billing workflow begins with patient registration. When the patient comes to your healthcare facility, it must be accurately registered. Collecting all necessary information and entering it into your system will eliminate one of the most common reasons for claims denial, which is incorrect demographic or insurance data.

Insurance verification

After the patient is registered, it is pivotal to verify their insurance. An in-depth research will minimize the chances of denied claims.

The main purpose of doing an insurance verification is to check whether the patient’s insurance policy covers the services the patient is supposed to get from your facility. This is done by checking the patient’s eligibility, coverage limits, and deductibles. For some treatments and procedures, a pre-authorization might be required.

Code selection

The Current Procedural Terminology codes and International Classification of Diseases codes are used to translate the internist services into billing charges. 

The coding team should check the patient’s medical procedures, diagnoses, and services and translate them into standardized codes so a claim can be created.

Claim creation and submission

The anatomy of a medical claim consists of:

  • Claim ID
  • Open events
  • Patient information
  • Provider data
  • Codes
  • Claim lines
  • Payment information
  • Attachments

Typically, all of these components are organized into two sections – a claim header and a claim detail. Once the medical claim is finished, it should be submitted to the relevant payor, the insurance company, Medicare or Medicaid. Generally, the claims submission process is done electronically, but in some cases, the claim can be submitted in paper form.

Claims adjudication

When the payor receives the claim, the process of claims adjudication starts. The payor evaluates the claim, and checks whether it is accurate and in compliance with their guidelines. There are three possible outcomes:

  • Claim accepted in full
  • Claim adjusted for partial coverage
  • Claim denied altogether

Claims denial management

In cases where the claim is adjusted or denied, the internal medical billing team should continue with proper claim management. Different strategies can be utilized for denial management, and the most effective ones include:

  • Immediate follow-up
  • Identifying trends
  • Finding the root cause for denials
  • Preventing common reasons for rejected claims
  • Appealing the denial

Payment posting

Payment posting is essential for revenue cycle management, as it logs payments into the system when they are received from the payor. The payment posting process should accurately document not only the payment amount but also all adjustments and accounts receivables.

Reporting and analysis

If you want to improve your internal medicine billing process, you should do regular reporting and analysis. Key performance indicators are excellent for identifying areas of improvement and tracking financial performance. Some internal medicine billing KPIs include clean claims ratio, denial rates, gross collection ratio, accounts receivable aging, and bad debt rate.

Payment posting

Coding and Documentation Excellence

As experienced coders and billers, let us share a little secret with you – the key to proper reimbursement is achieving coding and documentation excellence. To minimize the chances of denied claims, you should have a team of experts handle your coding process.

The selection of appropriate CPT and ICD codes can be challenging for internal medicine cases. Coding inaccuracies should be minimized because they lead to denied claims. The medical coding must be done precisely and according to the latest medical coding changes.

The medical coding process requires comprehensive training, keeping up with the latest updates, thorough and accurate documentation and utilizing advanced coding software. Ultimately, to significantly improve the accuracy of your organization’s coding and benefit from better financial outcomes, you should take regular quality control measures and implement necessary changes.

Optimizing Claim Submission Processes

When it comes to claim submission, we can help you optimize the process by implementing different strategies. No matter the approach, the goal of every strategy is to minimize errors and delays.

Here are the strategies that are proven to be the most effective:

  • Minimizing coding errors
  • Prioritizing rejected and denied claims
  • Focusing on clean claims rates
  • Improving the number of clean claim rates
  • Utilizing claims management software for billing process improvement
  • Tracking payer trends
  • Using electronic claim submission methods
  • Executing pre-claim audits
  • Using claims scrubbing for identifying coding errors on time

Proactive Denial Management

Proactive denial management in internal medicine billing involves a combination of strategies to prevent denials. Some of the strategies are not only for preventing denials, but might also assist you in effectively managing denied claims.

Identifying common denial reasons is an effective strategy for proactive denial management. It includes regular review of denied claims, looking for patterns such as recurring reasons and systemic issues. It’s best to utilize analytics software and identify trends that build over time.

Sometimes, comparing the denial rates with industry standards might also help. For example, the industry standard benchmark for denied claims is between 5% and 10%.

Furthermore, for a successful denial management strategy, the process for handling denied claims should be standardized. This also includes timelines for each step of the appeals and developing a system for prioritizing denials.

Outsourcing Solutions by CLICKVISION BPO

Having revealed what is internal medicine billing, you might be wondering how you can simplify this complex process without negatively impacting your budget. One of the best options is to outsource the medical billing activities of your organization.

Firstly, outsourcing will reduce your operational costs because, generally, the services cost less than having an in-house team for coding and billing. In addition, you will have more time to focus on core responsibilities, such as patient care.

At CLICKVISION BPO we offer tailored internal medicine billing services to your coding and billing needs. Our services are entirely customizable, allowing you to outsource only what you need.

Conclusion

Internal medicine practices are significantly relying on medical billing for streamlining revenue cycle management. Understanding what is internal medicine billing will bring you one step closer to financial health. As the process involves constant training and adherence to the latest billing guidelines and regulations, one of the most cost-effective options is to outsource internal medicine billing. 

If your healthcare organization wants to collaborate with an experienced team of medical coders and billers, don’t hesitate to contact us so we can create a tailored solution.