Billing Solutions for Infectious Disease Physicians

J3262 is the HCPCS billing code associated with bezlotoxumab. Practices should confirm the current code description, coverage requirements, units, and payer-specific billing rules before submitting a claim. Drug billing may also require accurate documentation, administration coding, benefit verification, and attention to whether the therapy is processed under the medical or pharmacy benefit.

Dalbavancin is billed using J0875. The appropriate units and billing documentation should be confirmed against the product administered, payer policy, and current coding guidance. Because infectious disease drug claims can be affected by authorization, benefit category, unit reporting, and NDC details, practices should validate the complete claim rather than relying on the J code alone.

Common challenges include under-leveled visits, missed drug or administration charges, incomplete consult documentation, authorization gaps, medical-versus-pharmacy benefit confusion, coding errors, denials, underpayments, and aging A/R. Practices may also have coverage or stewardship agreements that do not clearly compensate the work performed. Reviewing the full workflow helps connect each financial issue to its operational source.

Yes. The service catalog includes support for infusion and OPAT workflows, including eligibility and benefit verification, prior authorization, drug and administration claims, coding review, denial management, payment reconciliation, and A/R follow-up. The relevant billing approach depends on the service, documentation, payer requirements, acquisition model, and whether coverage falls under a medical or pharmacy benefit.

Revenue leakage can be traced through reporting by payer, service line, and provider, alongside review of documentation, charge capture, contracts, claims, payments, and A/R. Useful findings may include missing drug or administration charges, under-leveled visits, short-pays, incorrect fee schedule application, unit mismatches, unresolved denials, or balances that were not actively pursued.

Revenue-cycle consulting can examine the workflow from referral to first dose through final payment. Areas may include documentation, coding, eligibility, prior authorization, drug acquisition, infusion billing, denials, underpayments, A/R, payer contracts, and hospital coverage agreements. The outcome is a prioritized view of where revenue is delayed, lost, or left uncollected and what process changes may address it.

Payment reconciliation compares actual payments with expected reimbursement for drug, administration, and E/M claims. The review can flag short-pays, incorrect fee schedule application, unit or NDC mismatches, and other differences. Underpayments can then be disputed and tracked to recovery, while recurring patterns may point to contract, coding, charge-capture, or payer-processing issues.

Claims management and overflow support can be structured around the practice’s existing workflows and systems. Typical activities include charge entry, coding review, claim scrubbing, submission, rejection clearing, and follow-up for E/M, infusion, and drug claims. The appropriate scope depends on the practice’s internal responsibilities, service mix, systems, payer requirements, and current claims workload.