Specialty billing
Infectious Disease Billing for Long, Complex Consultations
Prolonged consultative work, outpatient infusion therapy and preventive programs with strict coverage rules.
The challenge
What makes infectious disease billing different
Infectious disease is a cognitive specialty with almost no procedural revenue to fall back on. Value is produced through long, complex consultations, careful antimicrobial decision making and coordination across settings, and every one of those things has to be captured through evaluation and management coding to be paid at all.
That makes the specialty unusually exposed to under-documentation of time. A ninety-minute consultation on a multi-drug-resistant organism generates the same claim as a routine follow-up if the total time and decision making are not recorded in a way that supports the higher level and any prolonged service.
Why us
Why infectious disease practices work with us
Specialty billing is not a marketing label for us. Coders and A/R staff are assigned by specialty, so the person on your account reads notes like yours every day.
Get a free assessment- Prolonged service time captured whenever the documentation supports it
- Inpatient consultative work reconciled against the hospital record so nothing is missed
- Outpatient antimicrobial therapy billed across supply, administration and oversight
- Preventive programs handled under their own distinct coverage rules
Scope of work
What we handle for infectious disease practices
The work below is specific to this specialty, not a generic billing checklist with the name swapped out.
Prolonged service coding
Extended encounter time captured and billed where total documented time supports it.
Inpatient consultations
Hospital consultative work reconciled against the facility census so no encounter goes unbilled.
Outpatient antimicrobial therapy
Home and outpatient infusion coordinated across drug supply, administration and physician oversight.
HIV care and prevention
Ongoing HIV management and preventive programs billed under their specific coverage requirements.
Telehealth consultation
Remote consultative work billed with current place of service and modifier requirements.
Antimicrobial stewardship
Stewardship and advisory work captured where a billable service relationship exists.
The Right Way difference
What we watch on infectious disease claims
These are the details that separate a paid claim from an appealed one in infectious disease. They are checked on every claim, not sampled.
- 01 Total documented time on the date of service, which drives both level selection and prolonged services
- 02 Whether inpatient consultative work has been reconciled against the facility census
- 03 Coverage rules for preventive programs, which differ substantially from treatment coverage
- 04 Drug supply versus administration versus oversight, billed by different parties in home infusion
- 05 Medical necessity documentation for extended antimicrobial courses, a frequent review target
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Years running revenue cycles for physician practices
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Providers billed for across every specialty we serve
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First-pass clean claim rate
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Median days in accounts receivable
Questions
Infectious Disease billing questions
What practices in this specialty ask us most often before making a change.
Ask us something elseOften, yes. Prolonged services exist precisely for this, but they require total time on the date of service to be documented properly. In our experience this is the single largest recoverable gap in infectious disease practices.
Yes, including the coordination problem it creates. Drug supply, administration and physician oversight are often billed by different entities, and the physician oversight component is the one that most frequently goes unbilled.
That is standard for us. We match your consultative activity against the facility census so encounters that never made it into your billing system are caught rather than lost.
How it works
Getting started takes about a month
The same four steps whichever specialty you are in. No system migration and no gap in your cash flow.
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01
Revenue assessment
We audit a sample of your claims, denials and aged A/R and show you what we found. Free, and yours to keep either way.
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02
Scope and agreement
A written scope covering exactly which services we run, what it costs and what we are accountable for.
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03
Access and onboarding
We set up inside your existing EHR and clearinghouse. Two to four weeks, run in parallel with your current process.
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04
Live and reporting
We take over submission and follow-up, and you get monthly reporting you can actually act on.
Free consultation
Let us look at your infectious disease claims
Send us a sample and we will tell you specifically what is being coded, denied or under-paid — and what it is worth to fix. Free, and yours to keep.