SpecialtiesMedical specialties
How we see hepatology billing.
Reviewed by the VisMed medical specialties billing team
A hepatology practice manages viral hepatitis, fatty liver disease, cirrhosis and transplant patients with medications that are among the most expensive in outpatient medicine. Payers respond with authorization requirements, step therapy, specialty-pharmacy mandates and site-of-care rules. Every one of those is a place where a dose is not paid.
The visits themselves are long and complex, with data review and coordination that supports higher E/M levels and, for transplant and decompensated patients, care-management codes. Practices tend to bill them modestly and leave the coordination unbilled.
VisMed opens each drug course as a case at our authorization desk, with the plan’s criteria checklist, gathered documentation and tracked status, and our coders review complex visits so the reasoning in the room reaches the claim.
Where hepatology practices lose money
The patterns we find in the aging and denial history before anything else changes.
Antivirals and biologics without a clean authorization
Step-therapy, genotype, fibrosis-stage and lab criteria differ by plan. A request that does not meet the plan’s checklist is denied and delays treatment.Buy-and-bill on drugs that pay below cost
Where the practice supplies the drug, some plans reimburse below acquisition. Infusing without checking is a loss per dose.Elastography and ultrasound component errors
In-office elastography and liver ultrasound need images retained and components billed by ownership and supervision.Complex visits leveled as routine
Decompensated cirrhosis management with medication changes and outside-record review is high-complexity. The note has to say what was weighed.Transplant follow-up and coordination unbilled
Post-transplant management and coordination with the transplant center supports care-management and prolonged-service codes that are rarely captured.
What we do differently for hepatology
Specialty-matched coders and a denials specialist, working inside your own system.
We run drug authorizations as cases
Each course gets the plan’s criteria checklist, the documentation gathered and the status tracked, with appeals and peer-to-peer scheduled before treatment.We check reimbursement before buy-and-bill
We compare allowed rates per plan with your acquisition cost, and route to specialty pharmacy where the numbers say so.We review leveling and prolonged services
Our coders read complex visits against the decision-making and time rules, and prompt for documented time where prolonged services apply.We map imaging components by site
Elastography and ultrasound are mapped to ownership and supervision at onboarding and billed correctly per payer.
What we bill
The procedure and code families your account team already works in.
Hepatology billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed handle antiviral prior authorizations?
As a case per patient per course. VisMed checks the plan’s criteria, assembles the labs and staging the plan asks for, and sends the request complete. Denials get an appeal or a peer-to-peer within days, not weeks.
Should we buy and bill or route to specialty pharmacy?
It depends on the plan’s allowed rate against your cost, and VisMed checks it per drug and per plan before you infuse. Where the office loses money, we route the drug to specialty pharmacy and you bill administration.
Can transplant follow-up support care-management billing?
Often, yes. Principal or chronic care management, and prolonged services when documented by time, fit post-transplant coordination well. VisMed sets up the consent and time tracking so it is billable.
We do elastography in the office. What is needed?
A retained image or report, the correct supervision, and the technical and professional components billed according to who owns the device and who reads. VisMed sets the rule per payer during onboarding.
How does VisMed handle specialty-pharmacy mandates?
We check each plan’s site-of-care and specialty-pharmacy policy when the course is opened. Where the plan mandates pharmacy supply, we route the prescription and bill only administration, so a dose is never given on a claim the plan has already decided not to pay.
Also in medical specialties
Cardiology
Diagnostics, device checks and cath-lab professional fees.
Endocrinology
CGM, infusion and chronic-condition management codes.
Gastroenterology
Endoscopy, ASC splits and screening-vs-diagnostic rules.
Nephrology
Dialysis MCP, monthly capitation and transplant follow-up.
Pulmonology
PFTs, sleep crossover and DME orders.
Rheumatology
Biologic infusions, J-codes and buy-and-bill.
Neurology
EEG/EMG, infusion and long-visit E/M.
Oncology
Chemotherapy administration, drugs and NDC reporting.
Hematology
Infusion and lab-linked visits.
Immunology & allergy
Testing panels and immunotherapy series.
Infectious disease
Inpatient rounds, long-term therapy and telehealth.
Dermatology
Lesion coding, pathology and cosmetic separation.
Pain management
Injections, ablations and strict authorization trails.
Psychiatry
Med-management with therapy add-ons, parity rules.
All specialties
The full list, in six groups
See where your hepatology practice is losing money. Free.
Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
or write directly hello@vis.med