The financial impact of the medical toxicology specialty code on a private practice

Abstract

Background: We describe the financial impact following the implementation of this unique specialty taxonomy code after October 1, 2017 on an established private medical toxicology practice.

Methods: Clinical financial data over a 1-year period (October 2016 through September 2017) prior to medical toxicology specialty CMS code implementation was compared to financial data (October 2017 through September, 2018) following implementation. The encounters were billed by current procedural terminology (CPT) codes through the same biller during these time periods. Initial claim denial data were tracked throughout the appeals process.

Results: Overall, our initial denial rate decreased by 1.2% (with Medicare denials decreasing by 1.6% – excluding eligibility denials), resulting in a corresponding increase in a clean claim rate of 1.2%. This saved our practice $5477, between the 2 fiscal years.

Conclusions: Medical toxicology specialty code implementation had an improved effect on our reimbursement denial rate to our practice.

Keywords:

• Specialty code
• reimbursement
• medical toxicology practice
• billing
• denials

Disclosure statement

No potential conflict of interest was reported by the author.