Cardiology being a highly specialized field requires accurate and efficient cardiology billing and coding practices. Due to the regular changes, innovations, treatment options and technology updates in cardiology, the billing and coding team too must be aware of the constantly changing billing and coding regulations, coordination of benefits procedures, and knowledge of Medicare, Medicaid and other insurance providers’ policies. If the billing practices are superior, by and large the outcome is positively impacted.
One of the key areas of billing and coding if to effectively read and bill for the physician’s prescription. Coders must be aware of the specialized coding with respect to surgical procedures such as heart catheterization, pacemakers, coronary interventions and peripheral vascular procedures. It is also critical of cardiology billing and coding experts to be aware of other treatments in cardiology such as in-office imaging, Doppler, implanted devices and other echo services and other follow ups. Applying modifiers is another critical element to strengthen the cardiology practice.
Challenges regularly occurring in cardiology billing and coding are human errors, insufficient knowledge about billing and coding rules or not coding to the highest specificity. Mistakes can also occur as cardiology includes other services such as blood tests, radiology tests etc. Further charges differ as per care and medication in a hospital or a day care facility. So which are the ways in which cardiology revenues can be increased and growth tracked:
- Minimize Human Error: The in-house or the outsourcing team must double check on the documentation and CPT, ICD-10 and HCPCS codes.
- Training: The billing and coding team must stay updated and be constantly trained on the latest changes in the billing and coding regulations.
- Documentation: All documentation must be complete without any inaccuracies. If this occurs too often, bills are denied and revenues get affected.
- Coding: Documenting the diagnosis is better than documenting the symptom. Correct diagnosis documentation will enhance correct coding.
- Audit: Have regular internal and external audits, especially before Medicare does one. This ensures that common coding errors are caught early and documentation errors are corrected.
- Modifiers: Sometimes it is necessary to mention modifiers along with CPT code. They are used in claims and are useful for payment policies.
- Post-Op Billing Opportunities: Diagnostics tests like device check, defibrillator checks, pacemaker checks if performed during a post-operative period (within 90 days) must be billed for separately. Remote monitoring is also recommended for the above mentioned devices.
- Heart Failure and Psychological Status: Medicare compensates for both these ailments. These also lead to an increase in patient visits thereby higher revenues.
- EHR: Electronic Health Records must be used for customizable flow sheets, smart charting and connections to other labs. EHRs also help in tracking patient data and assists in accurate documentation.
Billing is sometimes affected by sudden complications in a patient which requires added attention and time; or sometimes additional services/procedures require to be conducted for treating the patient. Accurate documentation is thus required at each step in the billing process. It is also suggested and becomes feasible too to outsource the cardiology billing and coding services as there are dedicated professionals for increasing the profitability of the practice. They are well aware of the billing and coding rules and leave only the patient care to cardiologists. They are regular with filing claims, coding and documentation and ensure least denials and if any, follow up on them soon enough too without leaving any gaps for further issues.
Following compliances also give faster returns in the revenue cycle and assist in growing the cardiology practice. When an increase in revenues is evident, it is an indication that the billing procedures are being managed well.