Patient Billing and Collections for Infectious Disease Practices

ICD-10-CM code B00.9 represents herpesviral infection, unspecified. The code identifies a herpesviral infection when the documentation does not specify a more particular condition or site. Coding should reflect the provider’s clinical documentation and the applicable coding rules. Practices should also consider whether additional documentation or a more specific code is appropriate before submitting a claim.

A complete process commonly connects registration, eligibility and benefits verification, authorization, documentation, coding, charge capture, claim scrubbing, submission, rejection handling, payment posting, denial follow-up, patient balance communication, and accounts receivable review. ID practices may also need controls for infusion administration, drug claims, OPAT services, hospital consults, and medical-versus-pharmacy benefit decisions.

Denials may result from missing authorization, incorrect drug or administration coding, medical-versus-pharmacy benefit confusion, incomplete documentation, eligibility issues, claim errors, or payer processing problems. Reviewing denials by root cause is more useful than treating each denial as an isolated event. The findings can guide payer-specific appeals and workflow changes for clinical, coding, and front-office teams.

Revenue leakage can occur before a claim is submitted through under-leveled visits, missed drug or administration charges, incomplete documentation, or contract issues. It can also appear later through denials, short-pays, incorrect fee schedule application, aging claims, or unpursued balances. Reporting by payer, service line, and provider helps connect the missing revenue to documentation, charge capture, workflow, or reimbursement causes.

Payment reconciliation compares posted payments with expected reimbursement for drug, administration, and evaluation and management claims. The review can identify short-pays, incorrect fee schedule application, unit mismatches, NDC mismatches, or other differences between the claim and payment. Issues can then be documented, disputed, tracked, and reviewed for recurring payer or workflow patterns.

Aging accounts receivable should be organized by payer, service type, claim status, and balance so staff can prioritize unresolved work. Drug, infusion, hospital consult, and complex outpatient claims may require focused follow-up. Each contact and outcome should be documented, while recurring stalls are analyzed separately so the practice can address the underlying process rather than only pursue individual balances.

The responsible benefit can affect authorization, claim routing, drug acquisition, and reimbursement. Infusions and specialty drugs may require the practice to determine whether coverage falls under a medical or pharmacy benefit before treatment and billing proceed. Eligibility and authorization workflows should document the determination and connect it with the specific therapy, site, payer requirements, and claim process.

Yes. Revenue-cycle work for infusion and OPAT can include eligibility and benefit verification, prior authorization, documentation and coding review, drug and administration charge capture, claim submission, denial management, payment reconciliation, and accounts receivable follow-up. A workflow review can also examine how referrals, first doses, drug acquisition, clinical services, and final payment connect across the practice.