Increase Pay Up For Multiple Antibiotic Administrations

You can optimize reimbursement for antibiotic treatment by taking charge of multiple administrations by several different physicians for different diagnoses, says Dianna Hofbeck, RN, CCM, president of North Shore Medical Inc., a specialty medical billing service, in Abescon, N.J.

The administration of different kinds of antibiotics to treat different morbidities in one patient is quite common, according to Hofbeck. However, this situation presents dangers both to patients being treated for different conditions and to infectious disease (ID) physicians seeking reimbursement for treating those different conditions, she says.

For patients, multiple antibiotics can be counterproductive, rendering both therapies ineffective.

Multiple antibiotic treatments are red flags for case managers for physician offices and insurance companies who will deny payment on the basis of overlapping courses of treatment.

However, Hofbeck says, its up to the ID physician to take control of situations involving multiple antibiotic treatment. The ID physician is in the best position to manage the administration of antibiotics, which is part of his or her specialty, Hofbeck explains. Here is what the ID physician should do:

1. Question the patient. The ID physician should always ask patients if they are under the care of other doctors, and, if so, for what conditions. Often, for example, a woman may be treated with antibiotics for a gynecological problem that the ID physician is not aware of, Hofbeck.

2. Talk to PCP. The ID physician should discuss the patients course of treatment with the primary-care physician (PCP) but make it clear to the PCP that the responsibility for antibiotic treatment lies with the ID physician.

The ID physician shouldnt be the doctor of last resort, but instead the manager of treatment, Hofbeck says. If the ID physician cedes authority and responsibility for the administration of antibiotics to the primary-care physicians or another doctor, hell lose the ability to bill for those prescriptions and possibly for treatment of the underlying infectious disease as well, she explains. Hofbeck provides the following example to illustrate this point:

Scenario: A construction worker at a state park is bitten by a tick, developing a rash. He makes an appointment to see his primary-care physician, who diagnoses Lyme Disease and prescribes a course of oral doxycycline, a drug of choice for these kind of symptoms.

The construction worker then begins to feel sick, developing a severe, productive cough with green sputum, some flu-like symptoms and a fever of 103 degrees. He makes an appointment to see the local infectious disease physician in the community. The ID physician diagnoses pneumonia and either injects the patient with rocephelin or puts him on a course of Augmentin, asking him to return to the office in several days.

The construction worker, however, never [...]

- Published on 2000-05-01