The Centers for Medicare and Medicaid Services agreed to create a billing code that eases Medicare billing by distinguishing between heart failure specialists and clinical cardiologists, according to a statement by Heart Failure Society of America.
The new specialty code for "Advanced Heart Failure and Transplant Cardiology" will be in place for heart failure specialists and transplant cardiologists. The Centers for Medicare and Medicaid Services (CMS) has accepted the new specialty code for advanced heart failure and transplant cardiologists.
CMS sent a letter to the American College of Cardiology (ACC) and Heart Failure Society of America informing them of the decision and telling the agencies it could take a year to complete the entire implementation process. In the recent news; ACC said that the designation will allow CMS to distinguish heart failure and transplant cardiologists from clinical cardiologists when they bill for Medicare services.
With the new code, cardiologists and heart failure specialists from the same practice can submit separate billings if they treat the same patient. Initially, few Medicare carriers denied claims because they thought the cardiologists were guilty of duplicate billing.
The approval of the new heart failure specialty designation code is the culmination of years of collaborative work between the Heart Failure Society of America and the ACC. Ultimately; this will allow advanced heart failure/transplant cardiologists to be appropriately reimbursed for their care of a complex patient cohort.
This development should resolve the problem of claims being denied due to the appearance of duplicate billing. In the past, this has happened lot many times when the cardiologist and a heart failure specialist from the same group practice both billed to the patient evaluation and use the same code.
The new designation will let CMS to distinguish a HF/transplant cardiologist from a clinical cardiologist when billing for Medicare services. Previously there was no mechanism existed for CMS to accurately identify such category of physician for quality and payment programs. Some local Medicare billing companies have denied claims in the past, quoting duplicate billing, when a cardiologist and a HF specialist from the same group practice have billed for patient evaluation services.
Once CMS takes necessary steps to create the new code—which can take up to a year or more —it will allow for the reporting of the involvement of two specialty physicians providing distinct services to an individual patient. HFSA and ACC are requesting that CMS expedite the process to allow for payment.
This fall, CMS will be launching new billing codes for doctors who specialize in treating heart failure, rather than more general cardiologists billing for Medicare services.
Heart failure specialists receive more concentrated training than standard cardiologists and focus on taking care of patients with advanced heart failure or heart transplants. They treat more complex cases, and will be able to use their own CMS billing codes starting from this Oct. 1.
Heart failure patients account for large part of hospital readmissions given the severity of the ailment and treatment they need. The American College of Cardiology and the Heart Failure Society of America had been pushing for the billing privileges, as Medicare had denied specialists' payments when a general cardiologist in the same practice had also made a claim for the same patient.
The new billing codes for cardiology will be a critical milestone for advanced heart failure and cardiac transplant specialists, validating their critical role and contribution to patient care.