Operating a cardiology clinic involves much more than just diagnosing heart disease or performing a complex procedure. One of the most complicated and time-consuming aspects of operating a practice is the finance side related to insurance claims and billing. Practices face unique challenges in cardiology due to the high-cost and high-volume procedures, advanced diagnostic studies, and multiple insurance carriers. This is where cardiology billing companies offer very good value in helping practices optimize their revenue cycle, reduce denials, and stay compliant with regulations.
Complex Nature of Cardiology Billing
The complexity of cardiology billing arises from the type of procedures, tests, and treatments that are performed. Each service type - from echocardiograms to stress tests to interventional cardiology procedures such as stent placements and catheterizations has its own unique codes or Current Procedural Terminology (CPT) codes that must be used carefully and appropriately. Any misunderstanding or miscommunication of a code can potentially result in a denied claim, delay in payment, or underpayment. Cardiology practices regularly collect payments from multiple payers.
Importance of Cardiology Billing Companies
The complexities of the cardiology revenue cycle require the expertise of a specialized cardiology billing company to effectively handle it. The top priority of a medical billing company is to effectively manage the revenue cycle from beginning to end, and to verify that a claim has been submitted correctly and in a timely manner. Additionally, it has to satisfy the payer's processing rules. Specialized cardiology billing companies will provide the following services:
• Coding and documentation: Professionals trained in cardiology medical billing and coding knows which cardiology-specific CPT and ICD-10 codes to use. This will minimize the risk of errors which can cause claims to be denied. They also ensure proper documentation to support complex procedures per payer guidelines.
• Insurance Verification and Eligibility checks: Insurance verification performed before services are rendered is essential in avoiding unexpected denials and also allows the office to collect patient co-pays.
• Claim Submission and Claims Follow-Up: A billing company will submit claims to the payer in a timely manner and track the claim payment through the process. If the verification is denied, a billing company will be able to manage the re-submittal and appeals process.
• Denial Reports: Compliant revenue cycle billing companies will systematically look for patterns of denials, identify issues with payer systems during reporting, and also provide recommendations that can be applied to workflow design. The objective is to regain missed revenue and to begin the process of mitigating future denials and their revenues.
Benefits of Outsourcing Cardiology Billing Services
Most practices understand that outsourcing their billing will free up time and limit errors, but there is more that can be realized and utilized:
Specialized Knowledge in Cardiology Billing: Not all medical billing services have experience with the nuances of cardiology billing. Having a biller that is trained specifically for cardiology will allow for correct coding.
Improved Patient Financial Experience: Professionals in a cardiology billing company always know how to handle patient statements, co-pay collections, any potential billing hurdles, thus saving you from claim denials and payment loss.
Compliance with Regulations: Cardiology billers need to possess the complete knowledge of HIPAA and specific payer compliance. Every billing company worth its salt will invest in staff training and continuous improvement measures.
Financial Benefits of Engaging Cardiology Billing Companies
Having a billing company can actually alleviate a practice's financial condition. Depending on the criteria mentioned throughout the article, practices that utilize billing companies can expect to receive the following benefits:
Decrease in Claim Denial Rates: When using accurate coding techniques and following closely with the insurance payer, practitioners can often expect to decrease the percentage of claims denied.
Improved Payment Turnaround Times: When claims are accurate, the payment turnaround time improves. Improved turnaround means better cash flow for the practice and less financial burden.
Operational Cost Savings: Maintaining an in-house billing employee could be expensive when it comes to salary, training, and software costs. By utilizing a billing company, practices can afford to utilize a skilled professional at a fraction of the cost.
Choosing Cardiology Billing Professional
Choosing a billing company is important. The practice should seek a billing company that specializes in cardiology, has proven records of decreasing denials, and provides reporting transparency.
Cardiology practices function in a specialized and high-stakes medical environment where attention to detail in all procedures is essential. Therefore, outsourcing billing to a company with knowledge of cardiovascular care can save time, relieve stress, enhance revenue, and increase compliance. Through technology, expertise, and specialized knowledge, cardiology billing companies allow physicians and staff to concentrate on delivering excellent patient care while truly ensuring the practice remains profitable and efficient.
Vendors offer specialized cardiology billing services tailored to their specialties as well as full end-to-end revenue cycle management. This allows practices to reduce their administrative burden, so they can focus on patient care. Providers can lower costs by as much as 80% through outsourcing, with hourly rates starting at $7.