Cardiology Medical Billing
Before we dive into cardiology medical billing, let’s have an overview of what medical billing and coding are and their importance? It is a process of submitting insurance claims to the insurance providers (payers) against the healthcare or medical services provided by the physician to the patient. Medical billing for cardiology depends on the cardiologist’s situation or the place of service, whether it is a private clinic or a hospital. Cardiology is complex, and technology is constantly changing. Now and then, new techniques are being introduced, cardiologists deal with the vital organ of the human body – the heart! They are constantly under pressure with all the invasive procedures and bloodwork. With all of this going on, cardiology medical billing requires specialists to get the work done in time and do it correctly.
The ultimate goal of medical billing is to maximize the revenue cycle for the cardiologists against the services they render. To achieve that, outsourcing the cardiology medical billing services is an important decision. Cardiology in medical billing is a complex process and creating new challenges with all the requirements by CMS – Centers of Medicare and Medicaid Services, changing rules and regulations of the insurance payers, including the government policies. Using the correct codes and the right modifiers makes a huge difference. It results in an improved revenue cycle and lesser denials.
What are the challenges faced in cardiology billing?
There are a number of challenges faced by billers when making and submitting claims for cardiology medical services. One of the common errors is when the diagnosis and treatment codes used in the medical claim don’t match. This can lead to the insurance payer rejecting your medical claim.
Following are some of the common challenges faced in cardiology billing:
Use of Modifiers:
Modifiers are a crucial part of medical billing and coding. So, using the incorrect modifiers can lead to denied claims, therefore a compromised revenue cycle. Putting up a wrong modifier can also result in late payments and added workload – cleaning up the insurance claim!
At UControl Billing, we believe in increasing your revenue cycle so that you and your expert team of doctors can focus on the big thing, i.e. providing safe patient care! We handle everything from the claim creation to all the follow-ups and managing the denials.
According to an old saying, “If it’s not documented, it is not done”.
Proper and correct documentation is also one of the reasons behind denials, loss in payments affecting the revenue cycle. Proper documentation requires using the right codes and modifiers, the patient’s complete medical history and files, the number of procedures involved, and medications. Incorrect patient information may include errors like wrong spellings of the patient’s name or other details. Complete documentation also means adding all the medical procedures and medical reports that are billable and qualify for reimbursement via the insurance payer. Documentation should be according to the standard of the insurance payer.
Codes for cardiology billing:
Using the right code (diagnosis code or symptom code) in cardiology medical billing and coding is important. It is recommended to use a diagnosis code rather than using symptom code for cardiology billing. According to ICD – 10 diagnosis code for cardiology billing has various combo codes and follows the “Code First” or “Code Also” coding condition. ICD – 10 comes with a number of combo codes, using the appropriate combination to describe a patient’s disease or condition – a crucial part! However, based on the insurance payer’s policy, the symptoms of the underlying disease can be highlighted.
ICD – 10 and CPT codes are regularly changing; the challenge is to be on top of this! The medical billers need to be up-to-date about the changes and amendments in the codes or rules and regulations. Therefore, the staff (medical billers) should have proper training. All of this helps improve the revenue cycle and avoid medical claim denials.
Coding comorbidities in the cardiology billing:
Comorbidities are the related health conditions along with the major condition. Adding comorbidities does two things; one shows the complexity of a patient’s condition, and two results in higher reimbursements. It helps the insurance payer determine the patient’s condition and expected cost.
Cardiology medical billing guidelines:
Another challenge faced by the medical billers in cardiology billing is the lack of compliance and information regarding the updated guidelines for patient coverage. The healthcare provider’s billing team must determine what tests or procedures are covered under the insurance company and the patient’s cut. The patient must also be kept in the loop – no surprises.
This is why outsourcing cardiology in medical billing can be beneficial. As you can do, handle the patient care end and not worry about the medical billing. But how is it beneficial? Medical billing companies are in the industry. They are up to date with everything, every change in the rules or codes for cardiology billing. Outsourcing medical billing services results in increased cash flows, improved revenue cycle, and a higher reimbursement rate with lesser medical claim denials.
Common Errors in medical billing:
Errors in medical billing result in claim denials, loss in payments, lower revenue, and reimbursement rate. Some medical conditions or procedures require to be charged under the same or single code. They are designed that way. When these services are charged under different codes, it is called unbundling. Unbundling can be avoided by being up to date about medical billing and coding trends.
Intentionally using the wrong code when billing is known as upcoding and is an illegal act. Sometimes, a wrong code can also be entered by mistake – human error.
Tips for Improving the Cardiology Billing and Coding:
Medical billing for cardiology is complex and goes through or faces several challenges, including human error, lack of knowledge regarding the updates or changes in the guidelines or documentation standards of the payer, coding, or any other payer’s requirements. The following are some of the tips to improve medical billing for cardiology to avoid the mentioned challenges.
Decrease in Human Error:
With a complex procedure and a seven letters or digits code, chances of human error increase. This is one of the leading causes behind claim denials. Minimizing human error helps in lesser refusals and reimbursements.
Updated Coding Knowledge:
In cardiology billing, the concerned bodies constantly change the codes based on the new techniques and technology being introduced. Staying up to date with all the new changes and amendments in the ICD – 10 and CPT codes can be a real handful. They are constantly making amendments in the codes, and putting in the wrong code can result in denials. And if medical billers are not up to date with the changed codes or don’t use the latest code when billing, it can result in claim denials.
Proper and accurate documentation:
Complete and accurate documentation is a critical part of any medical claim. Incorrect or gaps in the documentation can lead to claim denials. For instance, physicians have to make an on-the-spot decision regarding the procedure in cardiology. This is why every detail should be available in the documentation to get a higher reimbursement rate and lesser denials.
Inaccurate or incomplete documentation results in a revenue cycle drop, decreased reimbursement rate, and lead to potential audits.
Use of Combo Codes:
For instance, if the patient also has another condition, using the codes for both diseases is recommended heart disease. In this scenario, combination codes can be used for cardiology billing. It is vital to use the codes for both conditions to get the reimbursements for all the medical procedures performed by the physician. What happens if we don’t use the correct combination codes? Loss payments, compromised revenue cycle, lower reimbursement rate, and the claim denials.
Outsourcing medical billing services to a competent firm like UControl Billing. A cardiology medical billing company is always updated regarding the rules and regulations, changes in the codes, etc. We at UControl Billing are determined to decrease your claim denials and increase the reimbursement rate.
Coding knowledge is one of the major reasons outsourcing cardiology billing is the better option as medical billing companies are up to date with the changes in codes and payer’s requirements, thus increasing your reimbursement rate.
Optimizing Cardiology billing and coding:
Cardiology billing requires critical and full attention. It is difficult for the healthcare providers to maintain both the medical billing end and the patient care end. In case of the unfulfillment of the payer’s requirements, resulting in denials.
But how to maintain an accurate system?
Outsourcing your cardiology billing and coding services to a medical billing company is the best option. At UControl Billing, we believe in adapting according to your needs. What benefits do you get outsourcing your medical billing to UControl Billing?
– High-level medical billing with an expert team
– Improved revenue cycle and reimbursement rate
– Flexible payment schedules (we only get paid when you do)
– HIPAA Compliance
– The choice of the billing system is yours.
Following are some of the reasons behind the popularity of outsourcing cardiology billing services:
- Physicians’ primary focus is providing healthcare services to the patients, performing the medical procedures they require, and not doing medical billing.
- Using the correct codes and proper documentation is essential for cardiology billing.
- But the medical billing for cardiology codes changes every year; being up to date with the changes, using the latest codes, and right modifiers are essential.
- Compliance with HIPAA is also necessary, which the medical billing companies ensure.
- WThereis a lesser administrative workload and staff training costs. with outsourced medical billing
With all the above, cardiologists get reimbursed according to the medical services and procedures they perform on the patients.
Why UControl Billing?
You get affordable and competitive prices by outsourcing your medical billing services to UControl Billing. Moreover, you don’t have to pay a fixed amount every month. For instance, your billing cost also goes down if your revenue or production faces a dip, i.e., we only get paid when you get paid.
UControl Billing offers you an end-to-end Revenue Cycle Management (RCM). At UControl billing, we adapt according to your needs instead of believing in “One size fits all”. With our timely follow-ups and 24-hour billing services, we consider ourselves a “Remote Business Office”.
Frequently Asked Questions (FAQs):
1. What is Cardiology in Medical Billing?
Cardiology in medical billing is a complex process. This field of medical billing faces constant changes and amendments in their medical procedure, techniques, technology, and therefore changes in codes, rules, and regulations. All of this requires using the right modifiers and principles for getting the reimbursements against the healthcare services provided by the cardiologists. These physicians are dealing with the most critical and vital organ of the human body, so their primary focus is to provide safe healthcare.
2. How much do the medical billers charge per claim?
Medical billing service providers typically charge about five to seven percent of the healthcare provider’s monthly revenue. This is a percentage-based charge for the medical billing services.
Some healthcare providers also tend to go for charges per claim as it is more convenient. One of the major reasons behind outsourcing cardiology billing is the convenience factors for the cardiologists.
3. What are the common medical billing errors?
Unfortunately, there are a number of errors when it comes to medical billing and coding. And all of these errors result in claim denials, loss in payments, lower reimbursement rates, and a compromised revenue cycle. Following are the common errors in medical billing and coding:
- Incorrect or incomplete patient information
- Wrong code and modifiers
- Unbundling in codes
- Under coding or upcoding
- Inconsistency between diagnosis codes and treatment codes
4. What is physician billing in medical billing?
Physician’s medical billing particularly deals with any medical procedures or services the healthcare provider provides. The physicians like Emergency Room (ER) physicians, surgeons, radiologists, or pathologists for cardiology medical billing can charge separate professional fees. Physician billing is different for every kind of physician. Physician medical billing ensures that the physician is being reimbursed for the professional services.
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.