In 2015, the American Hearts Association reported that nearly 800,000 Americans are affected by heart strokes annually. Further, given the lifestyle changes and the aging population, heart disease remains the leading cause of death in the US and accounts for 1 in every 4 deaths. This is thus a high number for medical care providers to manage in tandem with resources invested in providing advanced treatments and scientific research for newer treatments. In the backend of all this is the complex billing process and the claims submission. Cardiology billing becomes very crucial considering the volumes and processes involved.

Cardiology billing involves key processes like capturing patient demography, appointment scheduling, insurance verification, coding, payment and claims management, collections, account receivables, and reconciliation. The coding complexity brought in by the ICD-10 system and changing rules & regulations that cardiologists need to keep up with the newer treatments and innovations, often leads to inaccurate coding which can shrink revenue profit margins.

In-house billing teams are stated to leave at least 20 percent of the revenue uncollected! Additionally, the replacement of the fee for service by value-based performance has also made it difficult for cardiologists to comply with these complex business and clinical demands.

How then are cardiologists increasing their revenues?

The secret lies in specialized cardiovascular billing services. Only an experienced cardiac billing expert, preferably an outsourced billing service, can offer the medical knowledge and coding expertise that can help navigate insurance company billing procedures, or like the need for separate coding for therapeutic and diagnostic procedures; or which Cardiology-specific CPT codes cannot be used with a single specific modifier; or where non-congenital procedures are to be used as a single code, etc.

Today, more than 70 percent of medical practices are outsourcing their denial and AR follow-up tasks. Outsourcing these tedious and complex activities has been gaining popularity ever than before as these billing service providers are experts in this area and their only objective.

Reasons we know for this gaining popularity are discussed below:

  • Cardiology practice is a complex area and doctors' primary role is that of providing treatments to their patients and not billing.
  • On Oct. 1, 2016, the Centers for Medicare and Medicaid Services (CMS) released over 5,500 ICD-10 codes for the fiscal year (FY) 2017, including around 1,900 diagnosis codes (ICD-10-CM) and 3,651 hospital inpatient procedures codes (ICD-10-PCS) (reference American College of Cardiology).
  • Every year new CPT codes are introduced for newer technologies and procedures. Most of the new hospital inpatient codes released in 2017 pertain to cardiovascular procedures. These need to be reviewed carefully to ensure that the most up-to-date language and codes are used. Added to this is the understanding of when modifiers are to be used. Certain CPT codes cannot be used with modifiers.
  • It is imperative for all cardiology practices to have accurate documentation so that accurate codes are used for the medical procedures performed.
  • Cardiologists see a decrease in denials and revenues are maximized when the billing, coding, and medical billing process has been handed over to experts
  • Reducing Accounts receivables outstanding is a key area that outsourcing experts focus on. This involves tracking and reporting to the cardiology practice through aged collection reports. It involves claims follow-up from submission to payment through the collection.
  • Ensures HIPAA compliance as the medical billing service providers are committed to providing all necessary quality standards of the industry.
  • Have experts managing the revenue cycle management and concentrate on providing treatments to patients
  • Decrease in administrative workload is immediate relief, and the cost associated with staff training and retention eliminated
  • And above all- cardiologists are now getting paid for the services they have provided!

So it is in the interest of any medical practices, especially among cardiologists, to continue to keep outsourced their medical billing and claims process to be more efficient in the new MACRA programs and quality reporting audits.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. To know more about our Cardiology billing and coding services contact us at

Published By - Medical Billers and Coders
Published Date - Jun-14-2017 Back

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