Expert Cardiology Billing Service
Among all the medical specialties, cardiology is perhaps one of those that bill more than any other. A patient visit could require an office visit, EKG, echocardiogram, and nuclear stress test, all of which have their respective codes, modifiers and peculiarities. Where the complexity of the task is outsourced through expert cardiology billing services, more than a demonstration and pricing should be considered when making the selection.
Many practices come to know this only after falling into the trap. Though the company seemed to be good during the sales pitch, denials start to rise six months later and no one knows what to do. This is where the better strategy comes into play by posing certain questions before choosing the vendor. Here are ten of those.
1. How much of your work is actually in cardiology?
"We serve all specialties" usually serves as an alarm bell rather than an advantage. What one really needs to find is a company which is centered on cardiology and has such a client portfolio involving general cardiology, interventional and electrophysiology clinics. It is also important to know figures. Simply put asking questions about the number of cardiology clients currently working with the company and how long they have been there, is important.
2. Are the in-house coders certified, and do any specialize in cardiology?
Basic coding certification is compulsory. It is the cardiovascular knowledge that enables one to maintain the claims. The coder that deals on a day-to-day basis with CPT codes for cardiac catheterization, device interrogation, and stress tests sees all the errors that could have been overlooked by other coders. It is equally important to understand CPC or CCS and cardiovascular certifications.
3. How would you deal with complicated stuff like modifiers and bundling rules?
That is how a cardiology billing services provider earns their money. Modifiers 26, TC, 59, and 25 are used infinitely in the profession, and any misuse of the modifier results in denial and audit. Any respectable vendor should be able to tell you about the use of such modifiers correctly.
4. What EHR and practice management systems do the cardiology billing services company support?
Switching software is expensive and chaotic, hence, being compatible is an issue. The company should feel at ease with working within the practice’s software framework, whether that is Epic, athenahealth, or even cardiologist-specific one. Moreover, practices should find out the issue of charge capture, as unbilled charges can secretly eat up into the profit.
5. What does your claim scrubbing and denial management process look like?
Everyone claims that the clean claims ratio is high at their end. But what is essential is the way in which this figure has been derived. Ask whether the claims are usually checked according to the payer’s guidelines before being submitted and how they handle denial cases.
6. How do you manage prior authorizations?
Advanced cardiac imaging and some procedures require prior authorizations, and lack of it leads to denials which become unrecoverable claims. Thus asking questions on how the cardiology billing services provider handles the authorization, for instance how they management documentation, how aggressive are their follow-up strategies, which practices they use to note down authorization validity and so on, is crucial.
7. What reports do we get, and how frequently?
What we cannot see we cannot manage. Get reports on days outstanding in accounts receivable, denial ratios, collection ratios, and payer performance on a consistent basis. Generally, monthly is the norm, but most practices would rather have real-time dashboard. If your cardiology billing services vendor does not provide data, there is reason to wonder why.
8. How do you stay current with cardiology related payer and regulatory changes?
Changes to Medicare rules, annual coding updates, and other evolving policies affect the domain of cardiology more than any other. Find out what system the company uses to monitor and inform you of any changes. An organization with a procedure in place for the updates will ensure that there are no unpleasant surprises for your practice.
9. What are your fees for the cardiology billing services, and what is not included?
It is common practice for most cardiology billing services companies to bill at a rate that is a percentage of the total amount collected, usually between 4% and 8%. This is not enough information to make a decision on which billing company would be best for your practice. It is also important to know what the set-up fees and appeal fees are, if there are any extra fees for credentialing and so on.
10. Can we speak with current cardiology clients?
References are the most transparent part of the vetting process. The self-assured vendor will introduce a potential client to their existing ones with a comparable size and specialization. Such discussions must include issues such as communication, turnaround time, and problem-solving, since problems always arise sooner or later.
Reading Between the Lines
Not only are the answers important, the way answers are given is similarly crucial. A cardiology billing services team that answers clearly, admits weaknesses, and formulates relevant questions in return is likely to become a reliable partner. If a company is eager to conclude the deal right away, and avoids answering the performance-related questions, such vendor will most probably act like that later on as well.
It is essential to discuss data security as well. As billing companies work with protected health information, practices have to check whether the potential partner complies with HIPAA rules, how patients' data is stored and transferred and receive a business associate agreement.
Onboarding is another aspect to be considered. The successful onboarding process usually lasts for several weeks, and a good vendor will give the practice the detailed schedule including data transfer, credentialing checks, and training. Practices that overlook this point risk facing delayed claims at the moment when their cash flow is especially vulnerable.
Making the Final Call
The choice of a cardiology billing services provider revolves around trust, and trust requires transparency. Practicing transparency means that by asking these ten questions, one would clearly understand who knows cardiology and who does not. And in such a case, it is certainly better to know the difference even if it results in paying a higher price.
One may proceed by short-listing two to three vendors and asking the same questions to all of them. It would not take long to find out differences. The chosen partner should recover lost revenue, alleviate the administrative work of clinicians, and allow doctors to treat their patients rather than deal with paperwork.