Cardiology Billing: Heart-Healthy Solutions Unveiled March 21, 2024

Billing in cardiology practices isn’t just paperwork. It’s what keeps life-saving services going for patients. Despite its importance, cardiology billing poses a significant challenge for clinics.

Dealing with payment delays due to billing errors frustrates patients. On the other hand, cardiologists and staff feel stressed handling denied claims and extra administrative work.

Our blog delves into the everyday struggles of cardiology practices. We’ll look at how poor billing practices affect patients and doctors. Plus, we’ll share ways to make billing smoother so patients get the care they deserve.

Top Three Challenges of Cardiology Billing

Cardiology medical billing directly affects service provision. For example, if a cardiology practice submits claims with coding errors, they might get denied. This can lead to cash flow problems, making it hard to pay for staff, equipment, and supplies. 

As a result, the practice might struggle to keep up with patient care. Let’s look at how these challenges affect care delivery in cardiology practices.

1. High Coding Specificity

As billing rules change, accurate medical coding becomes more important. Cardiologists must document patient visits precisely, using codes like ICD-10 and CPT. Their codes affect how much they get paid and if insurance companies accept their claims. 

For example, if a doctor suspects angina pectoris during a visit but doesn’t do tests to confirm it, the physician might use a generic code like “Angina pectoris, unspecified” (I20.9). However, this lack of detail can cause problems with billing. The insurance company might deny the claim. They could say there isn’t enough information and ask for more details to justify the code chosen.

2. Increasing Claim Denials

Cardiology practices are seeing more insurance claim denials. A 2023 survey found that 49% of doctors sometimes had their Medicaid claims rejected or disputed. 

Denials happen for different reasons, like coding mistakes and missing paperwork. Claims might also get rejected if they don’t meet billing rules or aren’t necessary. Handling denied claims takes up much time and can slow down revenue. It can hurt the practice’s finances. Practices need to use good strategies to manage denials and cut revenue loss.

3. Low Reimbursement Rates

Some medical practices are facing challenges due to inadequate reimbursement rates. One of these challenges is the 3.37% reduction in Medicare payments for doctors’ services, which may be reduced by half depending on the actions taken by President Biden. 

These low rates make it hard to keep a cardiology practice going. They affect the practice’s revenue a lot. To deal with this, practices must talk to insurance companies about getting better rates. They might also think about diversifying revenue streams through value-based care and ancillary services.

A Quick Guide to Successful Cardiology Billing

To address billing issues, practices must take proactive measures. This includes the following steps:

Develop a Deeper Understanding of Insurance Policies

Clinics must keep up with coverage and policy changes. They should check reimbursement rates for services to see if there might be problems getting paid. Understanding insurance policies helps spot billing problems before they happen.

Ensure Your Billing Guidelines Encourage Accurate Documentation

Cardiology practices should train staff on coding and documentation rules. Doing regular audits helps find areas to improve and keep coding consistent.

Following cardiology billing guidelines correctly can help get payments faster. For example, there are some changes you should know about:

• E/M Code G2211: This new code is for ongoing care for patients with severe or complex conditions.
• G2066 was deleted: It was used for cardiac monitor and loop recorder remote checks. Now, these tasks use CPT codes 93297 and 93298.

It’s important to note that staff who aren’t trained well might struggle with these updates.

Consider Cardiology Billing Services to Optimize Billing Processes

Outsourcing billing to specialized services has many benefits:

• Cardiology-specific billing services have experts who know all about billing. They keep up with the rules and make sure that billing is compliant.
• By outsourcing billing, practices can focus on patients. Cardiology medical billing services handle processing claims and fixing claim problems. Both tasks take a lot of time. 
• Excellent billing services protect patient information and follow privacy rules. They use security measures to protect patient data.

Considerations for Choosing a Cardiology Billing Service Provider

When selecting a cardiology medical billing service provider, it’s crucial to consider several essential requirements. These are:

• Credentials. Choose a billing service provider with certified coders and billers. Look for credentials like Certified Professional Coder or Certified Coding Specialist. 
• Technology. Check their technology and software. They should use systems that support electronic claims and real-time eligibility checks.
• Revenue cycle. A strong technology setup makes billing more efficient. Pick a provider that’s proactive about managing revenue cycles. They should spot potential revenue problems and fix them. 
• Expertise. Make sure they understand cardiology billing codes. Experience with specialties or sub-specialties like interventional cardiology or echocardiography is valuable. 
• Customer service. Consider their customer service and communication. Choose a provider with responsive support and dedicated account managers.

Takeaway

Understanding cardiology billing complexities can be challenging, but proactive strategies can help. One strategy is to anticipate billing challenges by familiarizing oneself with insurance policies. Accurate documentation is also essential for coding compliance. 

When choosing a billing service, prioritize certifications. Ensure they have expertise in cardiology billing. It’s also crucial to choose a proactive service in revenue management.

Tap Into Our Expertise 

Maximize your cardiology practice’s revenue potential with 5 Star Billing Services. From echocardiology to transplant care, our certified coders ensure accurate billing and collection. 

At 5 Star Billing Services, we initially evaluate your practice and accounts receivable. Our services include account receivables management, 12-hour claims processing, and quality assurance checks. From modifier applications to system-based claims scrubbing, we cover it all.

Experience the difference with 5 Star Billing Services. Call 480-999-0180 to take the first step towards financial success.

Sources:

1. American Medical Association. “Latest Medicare Physician Pay Cut Shows Desperate Need for Overhaul.” American Medical Association, 6 Mar. 2024, www.ama-assn.org/practice-management/medicare-medicaid/latest-medicare-physician-pay-cut-shows-desperate-need.

2. Fitzgerald, Erin. “Why Coding Specificity Matters – AAPC Knowledge Center.” AAPC Knowledge Center, 1 Dec. 2022, www.aapc.com/blog/86777-why-coding-specificity-matters.

3. “Heart of Health Policy | Coding Corner: New Year, New Codes – American College of Cardiology.” American College of Cardiology, 1 Feb. 2024, www.acc.org/Latest-in-Cardiology/Articles/2024/02/01/01/42/heart-of-health-policy-coding-corner-new-year-new-codes.

4. Nelson, Jennifer. “Physician Survey: Biggest Headaches for Doctors Working With Medicaid.” Medscape, 9 Aug. 2023, p. 6. www.medscape.com/slideshow/2023-docs-medicaid-6016579#6.