Improve Accuracy and Practice Performance with A Perfect Cardiology Billing Service Partner

A recent report shows cardiology billing has a high error rate as it causes losses of over USD 3.2 billion each year. According to CERT data, the error rate is three times higher than the 10% Medicare average for improper payments. This is mainly due to weak billing and coding knowledge.

Heart disease is the leading cause of death in the US with almost 695,000 deaths in 2021, according to CDC. Roughly each heart disease death occurs every 33 seconds. Cardiologists are determined to fight this disease, and save life.

Despite their efforts, cardiologists face challenges with billing. These issues can hurt their revenue and threaten their practice’s survival.

Understanding Cardiology Billing Services

Cardiology billing services involve specialized billing processes designed for cardiology organizations. These processes include coding, submitting, and managing the insurance-related billing for cardiology tests, diagnostics, and treatments. The complexity and the considerable amount of care involved with cardiovascular patient care require a deep knowledge of clinical terminology and payer guidelines to handle the billing process in cardiology.

Every procedure and service in cardiology billing has its own unique CPT (Current Procedural Terminology) codes, ICD-10 (International Classification of Diseases) codes, modifiers, and paperwork. An error in coding can cause delayed payments, claim denials, improper payment, and failure to follow the guidelines of the payer.

Cardiology billing services assist practices to help them collect timely and accurate reimbursements from insurance, Medicare, and Medicaid payers. Billing services can be conducted and submitted to the office in-house or outsourced to a specialized company in cardiovascular billing. It assists with streamlining the revenue cycle as well as reducing time spent on administrative work. This will allow the clinicians to maintain their focus on providing quality care to patients while maintaining some stability in cash flow.

Characteristics of Cardiology Billing

Cardiology consists of complex procedures, from non-harmful test that measures the electric activity of the heart to help with diagnosing heart attacks or arrhythmias (also known as EKGs), to pacemaker insertions and angioplasties. The majority of the services have specific codes that must be coded, and documentation needs to be clear and accurate. Inaccurate billing can cause payment delays or denials.

There are many issues faced during cardiology billing. Most practices are unsure about specific coding and do not have staff members with extensive knowledge of cardiology. As a result, denials from payers may increase, with allegations of documentation errors or missing information.

On a similar note, rules regarding compliance issues are always changing, and payers are constantly updating the information. This adds the need for continual training and resources to keep up, or risk doing things incorrectly, or being non compliant.

Billing for the use of cardiac devices, such as a stent device or defibrillator, takes considerable attention to detail. Each device involves modifying billing verification. Outsourcing cardiology billing can alleviate many of these challenges. First, billing companies have trained coders with experience. Their focus is just on billing cardiology and ensuring they are aware of any changes to guidelines, modifiers, or payer policies.

Secondly, the staff will spend less time billing patients, giving them time for patient care, more workflow, and less burnout.

Thirdly, billing companies have excellent and often superior software to what is available, that will catch errors prior to submission, allowing for fewer denials and timely payments.

Finally, outsourced billing is almost always a boost to revenue. Billing experts will be able to identify missed charges or underpayments, which will bolster the practice's income.

Key Features of Quality Billing for Cardiology Services

A quality billing service should have:

• Proper coding and charge entry

This involves verifying that all procedures, diagnoses, and services are appropriately coded using the recognized coding schemas (ICD-10, CPT, or HCPCS) – this is an essential component of the billing and reimbursement process. Charge entry is when the code or charge is accurately entered into a system. This needs the data to validate that the charges have not been undercoded, overcoded, or rejected.

• Claim Scrubbing and Submission

After review, the claim information is submitted to the insurance payer; this is the process where errors, inconsistencies, and omissions that would create a denial or incorrect payment are identified. This is a review of patient demographics, policy numbers, coding, and claims provider information to determine if it is accurate, valid, and has been verified, and documented checks. Next, the claim will be submitted electronically or manually to the insurance company for processing.

• Denial Control and Appeals

This entails researching to identify the reason the claim was denied, correcting that claim and resubmitting as appropriate, or, when applicable, writing an appeal letter to address the denial and challenge the decision, with the intent to educate the payer and generate revenue.

• Payment Entry and Reconciliation

The process of payment entry involves matching payments to claims and posting adjustments as needed, and looking at the variances between anticipated and actual payments. Ongoing reconciliation gives us confidence the account is accurately and contemporaneously reflected in the financial record.

• Patient Billing and Support

Generating and sending accurate patient statements for remaining balances owed after insurance payments, meaning sufficient support for patients when they inquire. For example, explain charges, set payment plans if necessary, and resolve issues to ensure patient satisfaction and timely payment.

• Compliance Checks and Audits

Conduct a regular review of billing practices for compliance with currently accepted healthcare law, payer requirements for billing, and coding guidelines. This includes the conduct of internal audits and review of policy changes while ensuring documentation sufficiently supports billed services, which will also mitigate legal issues, fraud, and compliance violations.

• Reporting and Analytics

Generate detailed reports from more than one source of financial data and operations data to review key performance indicators (KPIs). KPIs will include claim acceptance rates, denied claims trends, days in A/R (accounts receivable), and collection rates, basically data to understand your revenue cycle better. Data-based insight will allow you to optimize your revenue cycle as you identify problems or areas that are improvement opportunities. Data-based reporting will allow accurate metrics of success as you involve the business discipline of Strategic Management.

These features provide smooth revenue cycle services and ultimately work to improve reimbursement rates and decrease the administrative burden.

The Benefits of Outsourcing Cardiology Billing Services

Lower claim denials

Expert billing staff knows how to remain thoroughly compliant with Medicare and Medicaid rules. It helps to keep claim denials to a minimum when they use the correct coding and document properly.

Higher revenue

The cardiac specialist can better ensure higher revenue simply by having fewer claim denials. Outsourcing allows for less interruption, fewer follow-ups, and quite a bit less wasted time. The work of any cardiology practice operates better with the billing process running more smoothly. An improving bottom line for a practice will occur when the cash flow is faster and more certain.

Better efficiency

Outsourced cardiology billing firms possess the expertise to focus on optimizing your entire billing process with advanced tools and processes. They take care of everything complicated, while their advanced billing processes reduce errors, and you have an increasingly accurate and efficient billing process occurring.

Superior compliance

The billing staff, coders, and other RCM personnel in a cardiology billing professional company in New York know what it takes to know what is happening in the newest form of Medicare and Medicaid guidance. This puts you on safe ground, preventing you from having claim problems and attracting payer audits. As a result, your billing becomes accurate and stress-free.

Better focus on patient care

Outsourcing cardiology RCM takes the pressure off your practice. Less time spent on billing and paperwork, so you and your team can spend more time actually caring for the patient and other tasks to grow your practice. You will also be able to spend more time with the patients, instead of working through upset claims, improving care and efficiency.

Reduction in costs

Cardiology billing outsourcing is an expense, but it is generally cheaper than doing it in-house. You don’t have to hire staff, purchase additional equipment or develop additional infrastructure, or establish office space for billing work. All of those costs go away. Instead, you simply select a package that fits both your budget and needs, where you are paying for the service, rather than all the added expenses.

In-House Vs. Outsourced Billing

Managing billing in-house in cardiology practices provides greater control and oversight of the entire revenue cycle process. Having a dedicated internal team means the staff will be very familiar with the cardiologists' procedures, documentation habits, and payer mix. Smaller cardiology practices may not adequately justify this overhead cost, which may be important if a staff member leaves and disrupts the billing and revenue processes.

On the contrary, outsourcing the billing function provides cardiology practices with specialty knowledge without the burden of a full-time staff with oversight responsibility. Outsourcing companies often employ experienced coders and billers who are compliant with the regulation changes and payer requirements regarding cardiology-specific procedures. If managed appropriately, outsourcing can lead to improved coding and fewer denials, automatic compliance changes, faster reimbursements, improved collections, management of claims, and overall time efficiency. Outsourcing allows providers and staff to retain internal time to provide patient care. Depending on the size and complexity of the practice and available internal resources, these benefits from outsourcing may outweigh the risks of decreased control over the billing function, communication delay, and data security.

Billing is an essential element, being a part of the financial health of the practice. Refocusing attention on patients and their healthcare can be advantageous when supported by having the billing handled the right way.

Outsourcing is the best option. A cardiology billing service has the opportunity to improve billing quality and efficiency in billing and payments, expediting revenue collection.

Through outsourcing, providers can decrease costs up to 80%, and have hourly services that start at an advance of $7. Vendors will offer cardiology billing services that are specialty-based, as well as full end-to-end revenue cycle management.