7 Questions to Ask Before You Step Towards Outsourcing Your Cardiology Billing

To attain cent percent perfection at cardiology billing is a far-fetched dream for most specialty clinics because of the extensive experience and knowledge it requires. ICD-10 comes with added complexities that raise the stakes for achieving accuracy. Add to its billing code changes and PMP for treatment of certain imaging procedures that often result in billing errors and stock of trouble for cardiologists keeps piling upward.

Billing for cardiology practices requires taking into account multiple procedure rules and complicated contractual adjustments, involving data collection from various sources. The use of modifiers in conjunction with CPT Codes makes it a complex procedure. For example, the codes 93451, 93456, and 93503 cannot be reported with modifier 51. Thus, cardiology billing requires billers to have updated knowledge about deleted codes, revised codes, and new codes. A medical practitioner trying to pace up with the advancement of cardiac care standards finds it difficult to manage such complexities of billing and coding. Recruiting and retaining staff for in-house billing can incur a lot of money, time, and carries risk.

Outsourcing cardiology medical billing to an efficient medical billing and coding company can help you move past the steep cost of in-house billing at the same time letting you avoid time wastage and averting risks. Moreover, hiring a billing and coding professional helps you with revenue generation, denial management and managing patient inflow and referrals, etc. However, narrowing down to a medical billing company to outsource the needs of your cardiology specialty clinic can be confusing.

Here are seven questions to ask before you step towards outsourcing your cardiology billing:

Question I:

Does The Billing Company Have Adequate Experience/ Credentials To Handle The Technicalities That Come With Cardiology Billing?

It’s important to be informed about the credentials of the medical billing company before you consider handing them over your billing and coding work. You can inquire if they are registered or licensed by the state they are in (if their state requires it). They also need to carry professional liability insurance. Gain knowledge of their agreement procedure as if they provide any written contract for their services detailing each party’s responsibilities in the association.

You need to know if the billing company understands the factors affecting your specialty i.e. cardiology. Get details about the number of past clients they have dealt with the same billing needs as yours. Don’t hesitate to get references, to contact current and previous clients and ask for their opinions of the service’s performance.

Question II:

What Kind Of Training Does The Staff At The Medical Billing Company Have?

Ask if they hold any certification from a professional billing organization and also if the staff of billers and coders professionally certified. It’s also important for a thriving service to provide ongoing education and guidance to its employees. Good billing companies have a written compliance plan in place, which you as a client must review. The team must have certified billers and coders to carry on the exercise and optimize the revenues of your business.

Question III:

What Is The Procedure To Protect The Privacy Of Information?

Check if the service has a compliance officer or some other who ensures the company provides secure email communications consistent with HIPAA requirements. If the billing company uses home-based employees they need to be more upbeat about their HIPAA compliance.

Question IV:

What Are the Company’s Technical Capabilities?

Does the company electronically process and submit claims, either directly to Medicare or through a clearinghouse? How often are the claims submitted to the Clearinghouse? What is the process that they follow for third-party payers? Reach an agreement with the service about the provision of help with forms, superbill design, office processes, etc.

Question V:

How Does The Biller Handle Claim Changes?

Obtain knowledge about the service’s protocol for changing CPT® or ICD-9-CM codes. You also must ask about the protocol they follow for missing information?

Question VI:

How Are The Billing Company’s Follow-Up Practices?

You need to know how successful they are with appeals. Inquire about the parameters they use to decide if they will appeal a denial or underpayment. A strong and efficient account receivable (A/R) follow-up procedure is a must for thriving practice revenue. Ask how often the service follows up on payer accounts.