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Medical billing services for cardiology is increasingly becoming more complex. Cardiologists still treat for health conditions such as coronary artery disease, high blood pressure, heart arrhythmia, aneurysms or valvular heart disease. Treatment details like the length of stay, resource utilization or morbidity have also always had a significant influence. However, new factors such as expanded requirements from the Centers for Medicare and Medicaid Services (CMS), new policies by private insurance payers as well as new regulations from state agencies have created new challenges for the field of cardiology. ABCS RCM is helping cardiologist adapt and meet the challenges of this changing healthcare environment.

The field of cardiology possesses several sub-specialties ranging from transplant and surgical procedures, interventional cardiology, echo-cardiology as well as general clinical cardiology. However, a common factor that unites these sub-specialties is that fact that generating and maintaining an accurate revenue cycle for many cardiologists is a challenge. Bundled payments, contractual adjustments, as well as the demands of insurance providers all create a more complicated billing process. Furthermore, radiology tests, blood work and inpatient/outpatient procedures add additional layers of complexity. So how can cardiologist operate in such a turbulent environment and still keep their practice financially successful? Here are three quick ways:

Code to the highest degree of specificity: One of the best ways to ensure that a cardiology practice’s revenue cycle is stable and optimized is to always code to the highest degree of specificity. This principle is one of the quickest ways to avoid costly denials from insurance payers. Coding to the highest degree of specificity means that clinicians use codes that provide the greatest degree of accuracy, specificity and completeness. Using unspecified codes when a more specific code is a better fit, will successfully pay some current healthcare claims. But these codes create long-term problems due to the fact that they may not support a more serious level of acuity in risk-based contracts.

Reduce input errors: We are only human is often used to justify mistakes, but this is not allowable in cardiac medicine. Forgetting to properly document a myocardial infarction in a patient’s medical records should not happen. Otherwise, there can be serious health consequences for a patient. Medical billing for Cardiologists must follow the same principle. Otherwise, there will be serious repercussions for that clinician’s revenue cycle. Correctly and quickly entering 5 to 7-digit ICD-10 and CPT codes is a challenge. This act is even more complex once a clinician adds multiple codes, procedures and modifiers. The billing personnel in the back office must stay up-to-date on ICD-10 CM, CPT and HCPCS codes. This includes being aware that there are frequent changes to the codes, or knowing to check both the alphabetical and tabular indexes.

Performing periodic audits: Without accurate and timely data, a practice will never know where they really stand. Auditing the work of a billing staff will catch many documentation mistakes and provide areas of education for a staff. In many areas of healthcare, numerous parties are involved in generating an accurate understanding of a patient’s level of acuity and general health. Frequent audits keep some of the parties in check and help to create and maintain accurate treatment documentation and reimbursements. Regardless of the type of audit performed (retrospective, concurrent, etc.), these actions will create a more complete picture of a medical practice’s revenue cycle.

Coding to the highest degree of specificity, reducing input errors and performing periodic audits will push a cardiologist’s revenue cycle in the right direction. Revenue cycle management for many cardiologists is challenging due to the fact that administrative requirements are increasing, while Medicare and Medicaid reimbursements have been declining. These practices need to operate in financially lean environments that require a stable cash flow and optimized medical billing service.

Cardiology, Medical Billing, ABCS RCM

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Helpful links:

American College of Cardiology

JACC: Journal of the American College of Cardiology

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