Medical Billing for Hospital Services

Medical Billing for Hospital Services

Hospital Services BillingAs we transition from fee-for-service to quality-based payment models, many hospitalists worry about getting adequate reimbursement. Hospital medicine is a relatively new clinical specialty. When DRG and RBRVU systems were created, hospitalists did not exist. Hospitalist coders need to be familiar with all of the internal medicine subspecialties and have a good understanding of many conditions and related treatments.

Knowledge of the intricacies of the Medical Decision Making components of the service is detrimental to accurate hospitalist coding. MPMRI Medical Billing hospitalist coding team offers you:


  • Years of experience in coding for and training evaluation and management (E/M) physicians to improve coding and documentation compliance.
  • Leadership by a nationally known E/M coding and reimbursement expert who is a certified coder.
  • A billing and coding team that focuses on hospital medicine reimbursement.
  • A fool-proof system that ensures no delays in payments.
  • Assistance with documentation for critical care time. The physician must use an appropriate critical care code when the patient becomes critical on the same day for which the provider reported an E/M service.
  • Assigning the right ICD-10 code, which is crucial for hospital service billing.
  • Knowledge of time-based coding techniques.
  • Complete understanding of observational care coding strategies.
  • Hospital discharge coding and related management codes.


Medical Decision Making E/M Coding and the IPPS

Hospitalist coding is algorithmically more complex than office coding, particular for the Medical Decision Making component of E/M coding. What works for one subspecialty may not apply to another, so hospital medicine billing and experience is critical. Our experienced and skilled coders use coding guidelines for hospital inpatient services that change often. To stay on top of coding for hospitalists, our professionals constantly review these rules and guidelines so there is no risk of denied claims.

Under the Inpatient Prospective Payment System (IPPS), Medicare reimburse hospitals a predetermined amount for inpatient hospital services, based on the patient’s condition and illness, as well as the respective classification under a diagnosis-related group. These services are often bundled based on diagnostic criteria. Our billers understand the 3-day rule regarding diagnostic services rendered during the DRG payment window.


Specialized Systems for Hospital Medicine

Hospital medicine is an expanding method of patient care that demands billing services by a company experienced in properly recognizing the care and collaboration provided by many medical professionals. The billing service must be capable of managing interrelated, complicated, and varied coding and contractual issues among practitioners and facilities. Medical Practice Management Resources Medical Billing has taken the time to develop a specialized set of systems to offer hospital medicine providers reliable and responsible billing support.

MPMR Medical billing has invested in state-of-the-art billing technology to make sure its hospitalist medical billing clients are provided the methods that will ensure maximum insurance reimbursements. To accomplish this, we use processes described as best practices, which are related to charge capture/reconciliation, denial management, and claims submission. For extra efficiency, we provide front-end edits that mean fewer re-files and appeals. The claims strategies used by XXXX Medical Billing maximize positive billing outcomes, which results in higher approval rates and claims clearance. Our processed claims average 95% on the first pass, which means a healthier accounts receivable for you.

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