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Ask the expert: What is a best practice billing protocol?

Hospitalist Leadership Connection, January 11, 2011

The majority of hospitalist practices receive financial support. The support may come from the hospital, physicians using the hospitalist services, national hospitalist companies, or insurance companies. To minimize dependence on this subsidy, the hospitalist program must have an exceptional billing team to maximize the practice’s accounts receivable and collection ratio.

The hospitalist practice may use a staff comprised of internal (e.g., hospitalist practice employees) or external (e.g., contracted service) billing personnel. In either case, billing services should have experience with physician billing. Many practices make the mistake of using hospital billers. These individuals are typically adept at billing insurance companies based on hospital charges but may not be proficient at billing physician services, as they may not be familiar with the nuances of physician billing.

The hospitalist practice must create a clear billing protocol in addition to assembling a skilled billing staff. The plan must address strategies to maximize charge capture and support timely submission of physician charges. The financial success of the hospitalist practice depends on the accurate tracking and capture of all physician services. The following are guidelines to support the billing staff:

• The practice must generate a hospitalist census sheet each morning that identifies all patients on the hospitalist service as well as all patients being followed as consults. The practice manager, practice billing staff (if they differ), and hospitalist providers must receive a copy of this sheet every day. Depending on the computer system used to retrieve this information, correctly identifying the attending physician can be a challenge. The providers must update the existing census sheet with new diagnoses for established patients, and with new admissions (including observation bed status), new consultations, emergency department (ED) consultations, and procedures performed. This must be accompanied by the diagnoses and appropriate ICD-9 (soon to be ICD-10) and/or current procedural terminology (CPT) code for all patients seen.
• The hospitalists must submit the billing information at the end of each workday and the billing staff must enter these charges on the next business day.
• At the time of discharge, all H&Ps, inpatient consultations, ED consultations, procedure notes, and discharge summaries should be reviewed by the billing staff and compared to charge entry data (e.g., billing records) to verify and capture all services performed for each day of hospitalization. The billing staff should also scan all patient accounts comparing dates for hospitalization with dates of charge submission. If a gap in hospitalization-to-billing dates exists, the biller must verify that the patient was seen on the day in question by reviewing the chart. If it is established that a service was performed, the provider must submit an appropriate diagnosis and ICD-9 (soon to be ICD-10)/CPT code for the missing day.

The above excerpt is adapted from The Hospitalist Program Management Guide, Second edition, published by HCPro, Inc.

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