Adult Critical Care -- The Medx Specialties


Adult critical care services involve high complexity decision making to manage, monitor, and treat a critically ill patient. Critical care billing is time based and we know the physician may spend billable time with a patient at bedside or elsewhere on the floor/unit reviewing test results, discussing the patient’s care with other medical staff or documenting the medical record. We have the experience to bill for the physician’s total time engaged in work directly related to the individual patient’s care.

Critical care and other E/M services are reimbursable for care provided to the same patient on the same date by the same physician or another physician in the same group or other group. We have the coding experience including use of modifiers for the physician to successfully report to the insurance carrier repeat critical care time.

We have many years of Intensive Care billing in several facilities in Southern California including a very large ICU in Los Angeles County.

Our office has expertise in helping the physician select the appropriate CPT code to insure maximum reimbursement for physician transport.

For fast, efficient billing, Hospital Based Practices need to have electronic connectivity with hospitals to retrieve medical records and face sheet information. We make all the arrangements with the hospital for electronic retrieval of patient information by preparing HIPAA Business Associate Agreement and having our IT staff meet with the hospital’s IT department.

We review the CPT charge code assigned by the doctor and eliminate any bundled codes which will cause a denial or reduced payment.

We determine new patient’s insurance by using the hospital’s information and then re-verify for insurance accuracy and eligibility prior to billing claims electronically.

A vigorous insurance follow-up system is utilized to collect on outstanding claims and we also leverage the reporting of unfair payment practices to the Department of Managed Health Care and Department of Insurance for slow payers.

We can also assist the physician group with insurance contract negotiations and credentialing.