How Accurate Cardiology Billing Improves Revenue Cycle Performance

Cardiology is one of the most active and complicated medical specialties. Whether you take care of patients in general cardiology, pediatric cardiology, or interventional cardiology, how you bill directly links to your revenue cycle. From complex procedures like iliac artery repair, a stent placement to routine ECG readings, all it takes is a minor error in the coding or documentation.

Why is Cardiology Billing So Complex?

Any cardiac procedure has its own unique challenges. Cardiology has a higher demand for hyper-details in documentation since many procedures have component parts that require the necessary documentation.

A routine ECG recording takes on a completely new dimension when payers expect documentation to justify reimbursement. Cardiology-related CPT and ICD-10 codes change routinely for billing clues as technology advances. Outdated codes or missing a modifier ultimately affects revenue and costly administrative penalty.

The field of cardiology contains various subspecialties, including non-invasive, invasive, and interventional, each with differing requirements for billing management. Whether doing coronary intervention, pacemaker insertion, or electrophysiology study billing, accurate billing is paramount. Accurate billing is not just about payment, but also about compliance, the overall business runs smoothly, and long-term financial sustainability.

Accurate billing in cardiology is important for more than just revenue. Billing inaccuracies may result in:

• Audit
• Damaged payer relations
• Cash flow challenges
• Reimbursement reduction
• Increased workload

Given the current challenges of shrinking margins and increased regulatory scrutiny, a cardiology practice cannot afford this. Valuable money can be lost quickly, making any expense a burden.

If you work with professionals who are experienced in cardiology medical billing, your practice would be less exposed to these risks and enhance your overall financial performance.

Fundamental Cardiology Billing Codes

Understanding the key codes to each common procedure is imperative to mastering cardiology billing. Here are some general categories of codes most often used within cardiology;

1. CPT Codes for Cardiac Device Implantation: 33202–33273

Device implantation requires precise coding due to the level of complexity and value of these procedures.

2. ICD-10-CM Codes for Cardiovascular Conditions: I00–I99

These codes represent diseases of the circulatory and must be linked to patients as well as the procedures that may have assisted in quicker acceptance of the claims.

Cardiology practices also use HCPCS codes in addition to CPT and ICD-10 codes in order to bill for supplies and other services. Tracking the annual changes to coding and Federal Compliance is a constant undertaking that may overwhelm many practices.

Challenges with Major Payers in Cardiology Practices

Payer requirements present specific challenges to cardiologists based on the individual and intricate nature of cardiovascular procedures. Some of the more frequently seen challenges include:

1. Costly and Complex Procedures

Cardiology has both invasive and noninvasive procedures with high reimbursement values. Each of these procedures has specific coding requirements and rules, which creates a higher potential risk for error.

2. Delay from Prior Authorization

Certain procedures such as catheterizations, stress tests, and device implantations require prior authorization. Delays in obtaining authorization can affect scheduling and reduce cash flow.

3. Increased Denial Rates

Increased denial rates in cardiology billing often stem from the following: coding errors, lack of supporting documentation, and failure to meet payer guidelines.

4. Changing Payer Policies

Insurance payers continually change coverage criteria affecting cardiac procedures, requiring practices to be up to date and prepare for denials.

5. Patient Responsibility Payment Problems

Higher deductibles and out-of-pocket costs make collecting patient responsibility more challenging, creating greater challenges in revenue cycle.

How Expert Cardiology Billing Reduces Compliance Burden, Increases Revenue

A professional billing team could streamline the entire billing process, decrease claim denials, and protect your revenue as they are familiar with the challenges of cardiology coding. Additionally, they will stay current with regulations that may affect your practice.

The combination of a specialty and software program results in increased revenue and this can be achieved through:

• Accurate use of CPT code, ICD-10 code, and HCPCS code
• Correct use of modifiers
• Timely submission of claims
• Reduction of billing errors
• Maximization of reimbursements
• Effective communication with payers

Selecting the Right Cardiology Billing Partner

It is important to find a billing company that specializes in cardiology. The ideal billing partner should have:

1. A proven track record of reduced denials
2. Knowledge of guidelines related to cardiology-specific billing
3. Transparent reporting and analytics
4. Strong compliance procedures
5. Experience with cardiology-specific EHR and EMR platforms

For many practices, outsourcing their billing to a cardiology-specific provider will take administrative work off their plates, increase accuracy, decrease stress, and ultimately increase profit. With a team that helps manage the billing, physicians will generally be able to spend more time seeing patients and will have the peace of mind that their practice is financially viable.

Many companies are now offering end-to-end revenue cycle services solely for cardiology. This means practices can operate much more efficiently, save on operating costs of up to 80%, with rates starting as low as $7 per hour.