How to Overcome the Effects of CMS 2013 Fee Schedule on Cardiology Billing

cardiologyCMS 2013 fee schedule brought good news for family physicians and primary care providers but it has proved to be a mixed bag for cardiologists with 2 to 6% cut in Medicare fees. At a time when cardiology practices are already vulnerable, cuts in payment for vital cardiovascular services have affected their revenue cycle.

  • Combined with 26.5% cut from Sustainable Growth Rate (SGR) and 2% cut related to the 2011 Budget Control Act of sequestration provisions, there has been a -2% impact on cardiovascular medicine
  • Creation of new evaluation codes and payment levels for certain complex cardiology procedures might reduce payment from 20-27%
  • The proposal for expansion of multiple procedure payment reduction for such services has been finalized. If a patient gets more than one cardiovascular service on the same day, technical component of the lower-priced service will be reduced by 20-25%
  • Cardiology practices will have to face 1.5% reduction or penalty if they fail to comply with PQRS and e-Prescribing standards
  • Therapeutic and diagnostic services have been kept under the 25% reduction ambit, leaving out various other services. With these changes, billers and coders at cardiology practices are finding it difficult to separate diagnostic and therapeutic procedures from others and assign the right codes

Solution for overcoming the effects of 2013 fee schedule:

If your billing is not efficient, the CMS fee schedule can push your practice in a financial turmoil. With healthcare reforms increasing billing standards, cardiologists need to gear up with best medical billing technologies, management and processes.

  • There is need to monitor the process of coding and claim filing so that patient record maintenance and documentation remains accurate
  • Cardiologists need to constantly update the billing system with coding changes
  • Invest time in training staff for regulatory changes and its impact on the billing and collection procedure
  • Meet requirements of insurance companies to handle claim filing process
  • Avoid claim denials by checking a patient’s medical coverage details with the insurance provider
  • Streamline accounts and revenue, adhere to regulations related to electro-diagnostic and laboratory tests to avoid minor errors
  • Handle HIPAA compliance, follow up with insurance companies, file and re-file claims to get timely payments

These sweeping changes in payment have made cardiology practices exposed to heavy revenue loss. To strike a balance between the above mentioned requirements and quality care, many cardiologists are seeking help from a medical billing company as these companies are competent in maintaining cardiologists’ revenue health regardless of the Medicare cuts. can solve all your cardiology billing concerns dictated by Medicare. We have been helping physicians across 50 states in the US with our cardiology specific billing experience. Our aim is to handle every coding and billing detail of your practice in impeccable turnaround time. While the team at MBC strives to handle your claim denials, improve access management and ensure guaranteed financial success, you can focus on provision of quality patient care.