Unique Challenges of Cardiology Medical Billing

1
Unique Challenges of Cardiology
Medical Billing
2
Unique Challenges of Cardiology Medical Billing

• Nature of Cardiology Medical Billing
• Billing and coding for any medical speciality
  offers unique challenges due to billing
  guidelines and constantly changing reimbursement
  policies from various insurance carriers.
  Cardiology medical billing offers unique
  challenges as various sub-specialities of
  cardiology are involved. Different
  sub-specialties like interventional cardiology,
  echo-cardiology increases the need of expert
  coders and billers. MACRA rules for cardiology
  are complicated and coders must know in-depth
  guidelines for interventional and endovascular
  procedure coding. Cardiac cauterization including
  bifurcation intervention versus branch
  interventions leads charting to the highest level
  of specificity (systolic or diastolic CHF
  compared to CHF unspecified). Also, frequent
  revisions of codes happen in procedures like
  iliac repair, angioplasty, stent replacement, ECG
  recording, making it difficult to receive
  accurate insurance reimbursements. Lets
  understand unique challenges of cardiology
  medical billing from insurance reimbursement
  point of view.
• Unique Challenges of Cardiology Medical Billing
• Some of the unique challenges of cardiology
  medical billing are listed below
• Provider cannot render more than one cardiology
  treatment per day, if so technical component of
  the lesser expensive cardiology procedure will be
  reduced by 25 percent which means only 75 percent
  of the technical part will be paid.
• For cardiology coding, a lot of combination codes
  are available with ICD-10-CM. Based on the
  patients conditions accurate combination code
  need to be used. For example, the ICD code for
  unspecified systolic congestive heart failure
  (150.2) differs from the code for combined
  systolic and diastolic congestive heart failure
  (150.4).

3
Unique Challenges of Cardiology Medical Billing

• Cardiology patients often face more than one
  diagnosis, also called comorbidity. When it comes
  to cardiology billing and coding, its important
  to document these comorbidities to help ensure
  your practice gets reimbursed as much as
  possible. When documenting different diagnoses,
  check the coding instructions and read the code
  descriptions carefully. In some cases, you may
  need a combination code. A combination code helps
  classify multiple diagnoses, a diagnosis with a
  complication, or a diagnosis with a secondary
  manifestation.
• Provider should know whether the codes they
  submit are accepted and have medical necessity to
  be performed. They should also know which
  modifiers to be used and component coding etc.
  CMS gives an exhaustive list of CPT codes for
  cardiology and it monitors whether the provider
  is correctly coding.
• Commonly used modifiers in cardiology coding are
  modifier-22, modifier-25, modifier 51,
  modifier-52, and modifier-53. Not using modifiers
  at all or inaccurate use of modifiers leads to
  reduced reimbursements or claim denials. For
  example, you may add modifier 25 to a patient
  visit where the clinician determined the patient
  needed a stress test at the end of the visit. Not
  using modifiers properly could result in lost
  revenue for your practice. In the example above,
  forgetting the 25 modifier may mean you miss
  out on reimbursement for the patient visit.
  Instead, the payer may lump together the visit
  with the stress test procedure.
• Cardiology charges are billed differently based
  on whether patient was treated in patient or
  outpatient or same day surgery or in the office
  location.
• Preauthorization of cardiology procedures is
  mandatory before billing to avoid authorization
  denials.

4
Unique Challenges of Cardiology Medical Billing

• Addressing Unique Challenges of Cardiology
  Medical Billing
• Above mentioned unique challenges of cardiology
  medical billing will increase claim denials,
  reduce insurance reimbursements and might attract
  external payer audit. There are few things your
  practice can do to address these billing
  challenges, mentioned below
• Get well versed with billing and coding
  guidelines for various payers. Know these payers
  billing guidelines and set up rules for unique
  edits. Every payer is different, so you must
  understand the billing and coding intricacies for
  each. Understanding the unique guidelines can
  help avoid denials and delays in payments.
• Its always a good idea to keep detailed
  documentation for each patient, including
  symptoms, diagnoses, comorbidities, tests and
  treatments. Make sure you keep track of all
  patient encounters and avoid waiting too long
  between the date of service (DOS) and entering
  charges. Having thorough notes will help your
  practice with pre-authorizations or
  certifications, as some payers require
  comprehensive patient notes. The notes will also
  help your practice if needs to appeal any claim
  rejections or denials.
• Verifying a patients insurance eligibility is an
  essential first step in the RCM and claim
  submission process. Your claim may not get very
  far if a patient doesnt have an active insurance
  coverage. As lot of population has lost its
  employment due to pandemic, its always advisable
  to check insurance coverage for every patient
  visit. Your billing workflow could check
  eligibility for the following weeks schedule,
  giving your team plenty of time to reach out to
  patients if there are insurance issues.

5
Unique Challenges of Cardiology Medical Billing

• Form a team of cardiology billing and coding
  experts. Internally audit your billing and coding
  process often to find patterns and errors that
  may be affecting your practice collections. Set
  up a thorough review and claim scrubbing process.
  Look for automation opportunities to avoid any
  human error.
• Legion Health Care Solutions is a leading medical
  billing company providing complete billing and
  coding services to ensure accurate insurance
  reimbursement for your practice. Outsource your
  billing and coding operations like cardiology
  coding, prior authorization, charge entry,
  payment posting, denial management, eligibility
  verification, and Accounts Receivable (A/R). To
  know more about our cardiology billing and coding
  services, contact us at 727-475-1834 or email us
  at info_at_legionhealthcaresolutions.com

6
(No Transcript)