Custom Medical Billing for Infectious Disease Practices in Massachusetts

Verify Medicare eligibility through the applicable payer or eligibility verification workflow before services are billed. Review the patient’s coverage status, effective coverage, benefit pathway, and whether another payer may be primary. For infectious disease services, also confirm whether planned infusions, OPAT, drugs, or administration are handled under a medical or pharmacy benefit. Document the verification and retain relevant details in the practice workflow.

Custom medical billing can include charge entry, coding review, claim scrubbing, submission, rejection clearing, eligibility and benefits verification, prior authorization support, denial management, payment reconciliation, and A/R follow-up. Infectious disease practices may also need support for E/M services, hospital consults, infusions, OPAT, specialty drugs, and contracted services. The appropriate scope depends on the practice’s workflow, systems, and service lines.

Yes. Infectious disease billing support can review the workflow from referral and authorization through first dose, claim submission, payment, and follow-up. Important areas include drug and administration charges, medical versus pharmacy benefit classification, documentation, coding, authorization, drug acquisition, and payer requirements. Reviewing these connected steps helps identify where an infusion or OPAT claim may be delayed, denied, underpaid, or left unbilled.

Common causes include drug or administration coding issues, missing authorization, confusion between medical and pharmacy benefits, under-documented consults, and mismatches involving units or NDC information. A useful denial process categorizes claims by root cause, payer, service type, and documentation issue. Payer-specific appeals can then be supported by the clinical record, while recurring findings are shared with coding, clinical, and front-office teams.

Underpayment review compares actual payer payments with expected reimbursement for drug, administration, and E/M claims. The review can flag short-pays, incorrect fee schedule application, unit mismatches, NDC issues, and contract-related discrepancies. Practices can then document disputes, track payer responses, and examine whether a recurring issue requires a contract discussion, workflow change, coding correction, or improved payment posting process.

Revenue-cycle consulting reviews the full path from referral to final payment. For infectious disease practices, that may include documentation and coding, eligibility, prior authorization, drug acquisition, infusion billing, denials, underpayments, A/R follow-up, payer contracts, and hospital coverage agreements. The outcome is a prioritized plan that connects each revenue gap to its likely source and identifies practical workflow improvements.

A/R support can organize aging claims by payer, service type, balance, and claim status, with attention to complex drug, infusion, hospital consult, and outpatient claims. Follow-up activity should be documented so the practice can see what has been requested and what remains unresolved. Reporting can also reveal why claims stalled, helping address recurring issues instead of only pursuing individual balances.

Claims management and overflow support can be structured around the practice’s existing systems and workflow. Typical activities include charge entry, coding review, claim scrubbing, submission, and rejection clearing for E/M, infusion, and drug claims. Before work begins, the practice should define access, responsibilities, documentation standards, escalation paths, and which services are included so support fits its operations.