Reduce claim denials with Cardiology Billing Companies
Every healthcare provider aims to improve their financial stability by getting timely reimbursement for their services. Most cardiologists are now hiring expert cardiology billing companies for timely claim submission and effective revenue maximization. With changes in lifestyle and increased work pressure, heart issues have become common even for young individuals. This has created the need for more cardiology clinics to address frequent heart issues like blocked arteries, heart valve disease, congenital defects, etc.
One of the major hindrances in cardiology billing is claim denials. If the claims are denied, physicians do not receive payments for their services. This creates an imbalance in their overall financial structure and affects the quality of patient care. One of the major purposes of hiring a professional cardiology revenue cycle management company is to reduce these claim denials and streamline the billing process.
Reasons for claim denials in Cardiology Billing
According to the Medical Group Management Association (MGMA), every healthcare practice should have at least 95% clean claim rate. Reworking denied claims costs approximately $10-$25 per claim, resulting in a significant loss of revenue. An outsourced billing company identifies and fixes the following claim denial errors to optimize the cardiology medical billing services.
1. Late submission of claims – Delayed claim submissions lead to instant rejection of payments from insurance companies. It also leads to revenue loss and increased administrative burden for appeals. Every insurance company sets its own time limit for filing claims. This is known as the timely filing limit (TFL). For instance, Medicare offers a time range of 12 months to submit the claims. However, private insurance companies have a time limit ranging from 90 days to 180 days.
The cardiology billing services follow a list of best practices to ensure that claims are submitted within the timely filing limit. These practices include:
Reviewing payer-specific claim submission deadlines
Regular filing of new claims
Appealing denied claims prior to the deadline
Utilizing digital claim submission systems to ensure timely filing
2. Incorrect documentation – Accurate documentation is the initial step towards a simplified billing operation. Any error in registering the patient's information, insurance policy number, and lack of supporting test results like ECG creates an increase in denied claims.
The outsourced medical billing companies use electronic health record systems to manage and update patients’ medical records on a real-time basis. Updated billing platforms like eClinicalWorks, CureMD, and NextGen Healthcare are used by expert billing firms to enhance documentation precision and completeness.
3. Coding discrepancies – Cardiology coding is complex and requires the application of correct modifiers, especially –59, -26, and TC (technical components). An incorrect code, missing modifier or under coding result in denial of claims by the payers. Some of the common coding errors include:
Incorrect CPT codes for catheterization and echocardiograms
Billing of CPT 93880 (for non-invasive cerebrovascular arterial study) more than twice in a year
Using the codes 93297 and 93295 together for remote interrogation device evaluations
Cardiology billing companies follow guidebooks that refer to the updated CPT, HCPCS, ICD-10, and PCS codes. They also follow the prescribed list of codes published by the American Heart Association to stay aligned with the coding changes. Apart from these, the cardiology medical billing solutions also adhere to the CMS and other regulatory bodies for coding requirements and policies.
4. Missing prior authorization – For every healthcare billing company, it is important to verify the payer’s insurance coverage policy and the services that are covered. Various cardiac procedures like pacemaker installation or implantation of hemodynamic monitors require authorization from payers. If these procedures are completed without prior authorization, the claim will automatically be rejected.
Cardiology coding services have trained staff who are skilled at handling prior authorization challenges. They also implement the use of advanced technology to identify the required authorizations and submit clean claims on time. In verifying the insurance coverage policies, billing companies focus on:
Lifetime coverage limit
Prior medical conditions
Change in employment or health coverage
Determining your facility’s network status
The cardiac care services not covered under the plan
Streamline your practice with expert cardiology billing companies
It is vital for healthcare providers to stay updated and provide quality patient care in today’s evolving healthcare regulations and policies. Keeping this in mind, many cardiologists are hiring outsourced radiology billing companies to reduce claim denials and maximize revenue generation. The professional medical billing firms employ trained staff, experienced in the various aspects and complexities of cardiology billing. They provide end-to-end revenue cycle management that includes 99.9% overall accuracy, 80% reduction of billing cost, 100% HIPAA compliance and service cost at $7 an hour. They have professional coders who are certified by the American Academy of Professional Coders (AAPC).
Partnering with an expert medical billing company like SunKnowledge, you will receive the benefit of virtual assistant services. These services include patient appointment scheduling, appointment reminders, answering patient appointment queries, and responding to voicemails. If your practice is experiencing frequent coding issues, you can rely on these cardiology billing companies. In case your clinic is facing other billing challenges like prior authorization, documentation, and claim submission, you can still rely on them. The unique benefits, like no binding contracts and 30 days of free trial, offer the opportunity to explore their wide range of billing services. They offer pre-billing, billing, as well as post-billing services that cover all your billing requirements.