Cardiology billing is one of the most complex processes. There are multiple reasons behind the complexity of cardiology billing.
Changing policies and regulations and some of the most complex treatments of cardiology make it more difficult for the health service provider to get their reimbursement easily. Also there are lots of challenges for the billing companies to handle the operations specifically for cardiology.
What is Cardiology Billing?
Like many other medical billing processes, cardiology billing works the same. But it is slightly complex for the physicians and for the billing services providers.
The system works in which the patient came for the services and after the pre-authorization by the staff member the patient acquired treatment and was charged.
In case he has been insured then his insurance service provider is liable to pay for the treatment. And the health service provider can get assistance in a way by forming an in-house team for managing billing activity and they can also outsource their billing to any medical billing services.
What is the Step by Step Process of Cardiology Billing?
Here is a step-by-step process of cardiology billing practice.
- First, the medical practice needs to acquire the complete information of the patient. It is also called the patient registration process.
- In the next step verify the insurance eligibility and responsibility of the patient.
- After the verification process, the medical practice can give them the services according to their coverage.
- In the next step, you have to generate a claim to get reimbursement from the insurance provider. The claim generation required a lot of proceedings like ensuring the appropriate use of a modifier and error-free coding also following the regulations of HIPAA and other regulators.
- After the adjudication by the payer, he might release the amount or deny it due to multiple reasons.
- You have to follow up on denied claims after finding out the proper reason behind the denied claim to get fair reimbursement from the cardiology treatment you rendered to the patient.
That was the brief breakdown of how a standard medical billing system works. On the other side, the working of Cardiology billing is very similar to the standard medical billing process but the addition of multiple medical processes is making it more difficult for the service providers to appropriately record all the procedures and modifiers, enhancing the chances of error in coding as well as record keeping so we will discuss how we can appropriately manage it to get maximum reimbursement.
How To Effectively Manage Cardiology Billing?
It’s important to fully understand the standard procedure to effectively handle the process that revolves around Cardiology billing. Here are some key steps you need to understand before applying for the claim.
Ensure the Accuracy in Records
In the very first step, the accuracy regarding patient information matters a lot. Because any mismanagement at this stage will further cost your practice a lot. There are lots of claims denied due to inaccuracy in the records. So it’s very important to eliminate the chances of error in record-keeping from the very first step.
Your front desk staff member should accurately record all the essential information from the patient. His name, his social security number, his address age, demographic information, and information about his insurance provider should be recorded accurately.
Make sure that you are communicating very well with the patient. It helps to sort out that thing at the very initial stage. Because better communication helps you to better understand the whole scenario.
Checking Insurance Eligibility
The insurance verification or eligibility process is one of the most important steps in the billing process. For the cardiology treatment, there are multiple options that need to be considered while addressing the patient.
These steps involved a proper diagnosis treating conditions, operations, and using multiple types of equipment. So as we can see there are multiple steps involved in treating a patient suffering from cardiovascular disease.
On the other hand, there are multiple services that are usually excluded from the general agreement of the insurance company.
In short, the Insurance company usually refuses to pay for the services just because they are not part of their agreement. And patients are usually ignorant of these conditions.
So it’s the responsibility of the healthcare service provider to check the insurance eligibility and coverage before rendering any kind of treatment.
Using Appropriate Modifiers/Codes
Cardiology billing is relatively difficult compared to other forms of medical services. It requires a team of professionals who actually knows the use of appropriate modifiers and accurate coding procedures.
Medical codes are sometimes very confusing especially when you are dealing with a cardiology medical procedure. This somehow can increase the chances of inefficiency so to make it efficient you need to double-check all the codes before the submission.
Many of the health service providers are aware of how many denied claims they receive from the insurance payer due to the use of inappropriate modifiers. So for an accurate billing process, the use of accurate modifiers is also very important.
Keep your Practice Up-to-date
It’s important for every practice that is providing cardiology facilities to keep themselves updated about the latest regulations. Follow the latest updated ICD-10, CPT, HCPCS codes.
You can also follow the latest trends and regulations by visiting the website of CMS and also following organizations like the American heart association and the office of the inspector general (OIG) to keep your practice up-to-date.
Should You Outsource Your Cardiology Billing?
Cardiovascular complications are one of the leading causes of death in the USA. And it is a need of the hour to maintain excellent facilities for the heart patient but for many service providers, the main concern is about the increasing financial burden and not effectively managing the revenue cycle management.
While it’s tough to cope with the new medical reforms and hire professionals at the same time for the cardiology billing services. There are chances that with all this management, patient care can be compromised.
Outsourcing is the best way for cardiology services to not only manage their expenses but provide excellent patient care. The medical service providers are experts in handling the billing services effectively.
Med-Miles can help you in your cardiology billing. We have the best billing solution with an excellent track record. Our goal is to make revenue cycle management more efficient for our clients. To get more information you can call us at 888-5989-181.