Optimize Reimbursements in Cardiology Billing

Being a cardiologist, you must go through the frustration of claim denials due to errors in cardiology billing and coding. The dynamicity of the healthcare industry in terms of coding and billing practices often seem overwhelming due to increased clinical responsibilities. Your billing staff need to constantly chase the claim denials while dealing with day-to-day clinical activities simultaneously. It leaves no room for work-life balance and induces staff burnout.

The Medical Group Management Association found that more than 60% of claim denials are never followed up and therefore results in almost 5-10% revenue loss in practices. This eventually deteriorates the service quality and financial health of the practice simultaneously.

Other Cardiology Billing Pain Points

1. Lack of authorization: The correct documentation plays a pivotal role in prior authorization of cardiology services. Your overworked staff might neglect authorization, referrals and percepts. This results in a hindrance within your billing process.

2. Absence of modifiers: The perplex and ever-changing coding requirements is a headache for effective billing practice. Along with the CPT and diagnosis codes it is necessary to identify modifiers related to the rendered services. The lack of use of the same can result in claim denials and loss of revenue.

3. Ever-changing coverage principles: Apart from the coding and documentation, insurance payers release company-exclusive billing guidelines which in fact vary in different states. As a specialty provider, you must understand the regulatory norms for fruitful contract and accurate reimbursements. If you miss the same before rendering the service, your patient might have to pay more out of pocket which will harm patient satisfaction.

4. Poor denial management: A constant follow-up for the accounts receivable is necessary for effective reimbursements. If your practice has a poor denial management system you might suffer the issues of aged AR buckets which will hinder your revenue.

Strategies to Maximize Reimbursements in Cardiology Billing

1. Invest in a robust billing system: Implementation of a sturdy medical billing system within your practice can be effective in the long run. Look for a system specially designed for cardiology billing practices that integrates charge entry, claim scrubbing and electronic remittance advice.

2. Focus on comprehensive coding guidelines: Cardiology coding guidelines are frequently changing. To eliminate the errors, you must learn about the current guidelines in coding and educate your staff regarding the same. You can take help from CMS website and American Medical Association’s book.

3. Implement data analytics: With the implementation of technology, you can enhance your overall coding and billing process. You can consider data management within your practice to analyze the performance metrics and key performance indicators. Through the data related to claim denial reasons and patterns you gain insights about the issues and make informed decisions in your medical billing and coding practices.

4. Consider outsourcing: Outsourcing a team of expert medical billers and coders can reduce the issues within your practice. An outsourced partner has a better understanding regarding regulatory and documentation requirements thus reducing errors in billing and coding process. Furthermore, they are well versed in different software systems which makes them more efficient in coding and billing practices.

The Bottom Line

Cardiology billing and coding are essential to run a successful practice. When you consider best practices within your cardiology coding and billing services you can reduce the claim denials. On the other hand, taking professional help from an outsourced revenue cycle management company can reduce the administrative burden of your staff. A genuine billing partner reduces your management burden, overhead costs and provides you with a transparent process which drives your ROI. Accurate healthcare coding and billing are pivotal for your practice’s financial health. Outsourcing a reliable partner for the same can help you make a strategic approach for your practice in the long run.