The Value of Outsourcing Cardiology Specialty Billing Amidst Changes to Medicare Reimbursement Rates

Any revision in Medicare reimbursement rates will have a direct impact on physicians’ medical billing, and cardiologists are not immune to the effects of frequent changes in Medicare reimbursement rates, announced by The Centers for Medicare and Medicaid Services (CMS) from time to time. While cardiologists or their billers could anticipate the extent of earlier revisions with a fair degree of accuracy, they might not have imagined what they would be encountering in 2013 – as per CMS would have to be prepared for a 2 percent cut over and above the possible 26.5 percent cut to fix Sustainable Growth Rate (SGR) formula. In addition to these general revisions, sweeping changes in rules governing evaluation of coders for certain high percentage cardio-vascular procedures, multiple procedure payment reduction, PQRS and e-prescribing, and value-based modifiers may potentially squeeze cardiologists’ revenues or operational margins.

One of the major changes that may hit cardiologists hard is the creation of new codes and payment levels for certain complex yet frequently encountered procedures. These new evaluation codes could potentially reduce payments from 20 to 27 percent depending on procedures. While representatives are negotiating with CMS for a more rational evaluation system, cardiologists or cardiology specialty billing will continue to be affected till such time when it may be revisited.

Another major concern comes from the CMS’ scheme for implementing a multiple procedure payment reduction to cardiovascular services. This could mean a reduction as high as 25 percent on the technical component of a service relatively less expensive than services performed on the same day. While this may not apply to office visits, most of the cardiovascular diagnostic and therapeutic services that happen to administer multiple services on the same day will certainly have to forgo a major chunk of their reimbursements.

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As usual there would be bonus or penalty depending on compliance or non-compliance with PQRS and e-Prescribing – CMS has already made clear that cardiologists will receive 0.5 percent bonus for successfully participation in PQRS, and also be vulnerable to 1.5 percent penalty or reduction for non-compliance PQRS and e-Prescribing standards.

And, value-based modifier that adjusts payment for quality and cost of care could either enhance or decrease the eventual payouts to cardiology practices. While this system is not yet mandatory, you never cardiologists may soon be asked to be part of it under Account Care Organization (ACO) model.

Amidst these sweeping payments changes, cardiologists could be vulnerable to revenue losses, which in turn might jeopardize their sustenance and growth plans. This concern necessitates the significance of cardiology specialty billing that is competent enough to keep cardiologists’ revenue health positive despite the inevitable Medicare cuts. has successfully mediated physicians’ medical billing outsourcing decisions in the past; majority of Medical Billing Practices in varied disciplines across the 50 states in the U.S. have made use of our platform to source the right and competent medical billing professionals. Given our equally commendable cardiology-specific billing experience in the past during times of critical medical billing issues, cardiologists should be able to respond instantly and amicably to these Medicare-dictated billing challenges, and keep their practices clinically and operationally efficient.