Wed, 06 Dec 2023

Is your Cardiology Medical Billing Process Fractured?

07 Feb 2023, 16:41 GMT+10

Cardiology practices remain busy due to the increasing number of coronary artery disease patients. In addition, it is one of the highest paid specialty and cardiology medical billing needs to be accurate to get paid fully. Similarly, cardiology is a complex practice consisting of several treatments and procedures. Due to continuous research in the medical field, the treatments and billing guidelines change. Following the best billing and coding practices lead to an efficient cardiology revenue cycle process. Let's discuss various aspects which adversely affect the cardiology billing process.

Insurance Coverage Details

Cardiologists should verify the insurance coverage details of the patients they are treating. This helps to know whether the patients are eligible for the services or not. Similarly, offering services which are not covered by the insurances lead to claim denials. As a result, cardiology practices make the revenue cycle inefficient. So, being careful before offering services to the patients. Also, prior authorization helps cardiologists to know about patient insurance coverage before time. Keeping in view that payers have specific guidelines which are important to consider while filing claims for reimbursements.

Paying Attention to Comorbidities

When cardiologists make more than one diagnosis, it is known as comorbidity. Similarly, comorbidities in cardiology include hypertension, diabetes, and COPD. In addition, cardiology billing services help cardiologists submit clean claims with comorbidities. Professional billers and coders understand the process of cardiology revenue cycle and enable practices to improve profitability. Getting reimbursements for all the services offered to the patients, it is essential to code for comorbidities. In case of having an in-house billing staff, the practice staff should be updated with the latest billing guidelines.

Using Incorrect Modifiers

Modifiers show additional information about the producer physicians offer to the patients. In addition, CPT codes used for billing cardiology services often need modifiers for complete explanation of the treatments. Some modifiers used to code cardiology services are 25, 22, 51, 52, and 53. Inappropriate billing and coding with errors in modifiers lead to claim denials and revenue losses. So, accurate codes and modifiers lead to clean claim submission and lesser chances of denials.

How to Prevent Claim Denials with Cardiology Medical Billing

Claim denials pose a threat to a successful medical practice when it comes to financial performance. Similarly, managing the billing process efficiently helps to mitigate the risks of losing potential revenue and get reimbursements on time. Delayed submissions lead to delayed payments and negatively impacts the revenue cycle. Hiring billing services for cardiology practices enable medical practices to streamline revenue cycle and increase collections. Also, consistent cash flow and bottom-line improvement are possible with an effective billing process.

Stay Updated with Payers' Guidelines 

There are certain sets of rules defined by payers to make sure the claims are submitted according to defined rules. In addition, every payer has defined its own guidelines and it is essential to stay updated with the guidelines to prevent claim denials. Also, understanding the defined rules and regulations of payers help cardiology practices to attain timely reimbursements. Further, the billing and coding team of cardiology practices need to stay focused while submitting claims to payers.

Accurate Clinical Documentation

Making sure that the clinical documentation is complete helps cardiologists to maintain an efficient RCM cycle. In addition, keeping all the details of patients, diagnoses, and treatments make it easier to track the details of services. Similarly, it helps to submit accurate details to the insurance payers to ensure seamless reimbursements. As a result, cardiologists attain an efficient revenue cycle process with accurate documentation. Keeping accurate information of patients, rendered services, and lab tests help cardiologists maintain complete information of patients.

Create a Mechanism of Eligibility Verification

Maintaining an efficient mechanism of verifying the patients' eligibility helps to submit clean claims. If the patient does not have an insurance plan which covers the services cardiologists offer, claim denials occur. In addition, third-party companies which offer cardiology billing services can help providers to verify insurance from payers. As a result, providers can check insurance eligibility prior to the patient visit to prevent the chances of claim denials. Medical practices need to save time and costs to streamline the RCM cycle.

Summing Up

A fractured cardiology medical billing process creates an inefficient revenue cycle process which results in poor financial performance. As the cardiologists have a busy routine, not having a clean claim submission process leads to stress and burnout. In addition, cardiology practices can outsource billing and coding to professional RCM vendors. As a result, it makes the billing process efficient and leads to full and timely payments from payers. The expert billing professionals are well-versed with the latest payer guidelines and know how to help physicians get paid completely. So, outsourcing billing services to industry experts can help improve financial outcomes significantly. Further, cardiologists can focus on improving the life of patients with quality care.

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