Post-Acute Billing & RCM: The Essential Guide
Post-acute billing & RCM is different
Medical billing & revenue cycle management in post-acute settings isn’t necessarily difficult, but there are a number of specific issues that need to be managed properly.
In post-acute care, medical billing and revenue cycle management function slightly differently than in other areas of medicine. Post-acute billing and RCM is not necessarily harder or easier than billing and RCM in general, but it’s vital that you and your billing team understand its idiosyncrasies.
This article specifically discusses billing issues for independent physicians and rounding groups who provide services in post-acute facilities.
We’ll cover:
Specific coding issues for post-acute visits
What you need to know about post-acute EHR software
The key distinctions between different types of Medicare
And more.
Ready? Let’s get started.
Coding Issues in Post-Acute Care
For independent physicians providing services in post-acute facilities, the billing code for every visit is always the same. This is true regardless of specialty, type of visit, length of visit, or any other differences.
For physicians coming from other care settings, this can be surprising, as well as a relief! Since there’s only one option, this aspect of billing & charting is greatly simplified.
The difference between records for each billable visit will be entirely related to the notes attached to the EHR record. This is just a brief, specific description of what was addressed during the visit. So while the billing code for physiatry, internal medicine, cardiology, nephrology, podiatry, infectious disease, psychiatry, behavioral health, or any other specialty are actually identical, the notes for each visit will vary.
In our experience, as long as physicians include detailed notes, claims will be paid without issue.
Key Issues with Post-Acute EHR’s & Practice Management Software
Post-acute facilities use specific EHR platforms. In our experience, the three most common are PointClickCare, MatrixCare, and Vision, although there are others.
For independent physicians and rounding groups, the most important thing to understand about post-acute EHR platforms is that they don’t integrate with practice management software. In terms of billing, this means your billing service needs to know how to access demographic information and other necessary data from the EHR and enter that data into your billing software. Any errors will of course lead to delays & denials.
From what we’ve observed, neither physicians nor billing companies will be aware of this issue unless they have previous experience in providing post-acute care. For doctors and groups who are just beginning to provide post-acute care, this issue can be both surprising and overwhelming, both because it requires a substantial amount of additional work, and because it often leads to large numbers of delays & denials.
However, a billing service that has experience in the post-acute world will be well-equipped to manage this issue.
Differences Between Medicare Plans
In post-acute settings, the vast majority of patients will be covered by some type of Medicare. This may be straight Medicare, a Medicare Advantage Plan, or a Medicare/Medicaid hybrid. In some states these plans may have different names.
From a billing perspective, the requirements for billing vary depending on what type of Medicare coverage the patient has. While the technical details are beyond the scope of this article, suffice it to say that this issue can lead to a huge number of denials if your billing service doesn’t know how to manage it properly. From what we’ve seen, the vast majority of medical billing services are completely unaware of the billing requirements for different types of Medicare in post-acute settings.
Once again, a biller with experience in post-acute care will likely have no problems.
Business Models & Issues of High Volume
In general, independent physicians and rounding groups see a fairly high volume of patients. Due to this high volume, it’s especially important to make sure everything related to billing and RCM functions smoothly, because even small problems will quickly lead to an enormous amount of work, as well as denials and delays in revenue. We’ve seen many examples of post-acute care providers who have had to overcome serious cash flow issues related to issues with their billing, especially a low clean claim rate. This is most common when just starting out, which can also be the most difficult time to overcome operations and revenue challenges.
Our team has extensive experience in post-acute billing and RCM. We’ve helped many, many providers solve their billing issues completely. We’d be happy to discuss any challenges you’re having, and help you figure out long-term solutions.