Specialty Medical Billing Services

What specialty medical billing is

Specialty medical billing is billing done by people who know the codes, modifiers, documentation rules and payer policies of one specialty, rather than applying general rules to every claim. A cardiology claim, a psychiatry claim and a DME claim fail for completely different reasons, and a biller who knows those reasons catches them before the payer does. Some practices call it speciality billing; it is the same thing. Our medical billing services by specialty are listed below, grouped by provider type and practice setting.

Why general billers lose money on specialty claims

• Modifiers: 25, 59 and the X modifiers decide whether a second service is paid. Used wrongly they deny; used too freely they invite audits.
• Global periods: surgical specialties lose follow-up visits billed inside the global period, and miss the ones that are separately payable.
• Add-on and time-based codes: psychiatry, therapy and critical care are paid on documented time, and the thresholds are strict.
• Component billing: radiology and cardiology tests split into professional and technical components.
• Prior authorization: imaging, infusions, DME and behavioral health each have their own authorization rules.
• Cosmetic versus medical: dermatology and plastic surgery claims turn on whether the service is medically necessary.

Denial patterns by specialty

Multi-specialty groups and choosing a specialty billing company

A multi-specialty group needs one billing team that applies each specialty's rules to each provider's claims, not a separate vendor per department. Whoever you choose, ask four questions: which billers will work your claims and what they have billed before, how denials are worked and how often, what the monthly report shows, and whether they work in your current EMR. To outsource the whole revenue cycle, see outsource medical billing.