In cardiology practice, coding and billing require the cardiology biller to understand and work with complex procedure rules and contractual adjustments while keeping up-to-date with the changing codes and billing regulations. Though using CPT codes can be challenging, mainly when modifiers are to be used, it becomes more stressful for the biller when codes are revised, new codes are added, and some are deleted. All this indicates that cardiology billing poses quite a unique set of challenges and opens a path for error. Thereby, the cardiology billing errors would lead to a loss of revenue and negatively impact the practice. But there are several ways to avoid errors in cardiology billing, which will warrant uninterrupted revenue collection while you can better care of the patients. These are as follows:
Undoubtedly, ensuring correct and complete documentation is a must in cardiology billing. But simultaneously, the tricky nature of cardiology documentation can result in gaps in the billable codes used for the procedures. Thereby, every cardiology biller is required to deal with multiple codes for every cardiology patient and the complex processes of entering up to seven numbers and letters for every code.
Double-checking these multiple codes is necessary when the biller gets accustomed to the most often used ICD-10 and CPT codes. It leaves no room for unwanted and careless mistakes and a loss for entering specialty codes. Entering the exact procedural codes are must for submitting accurate and complete billing documents to the insurance company. Any incomplete or incorrect documentation will result in claims denial or rejection, which will slow down the practice.
2. Billing & Coding Changes
Cardiology is a complex field of healthcare practice that changes with its medical billing guidelines, changes, updates, or deletion of codes related to the procedures. The cardiology billing team must thus stay equipped with the latest billing practice changes. It is a must to refer to the CMS website for updates and to keep up with the state and local billing authorities and their regulations. Any failure to stay up-to-date with the changes will result in cardiology billing and coding errors, affecting revenue.
3. Combo Codes & Symptom Codes
ICD-10-CM has a range of combination codes for different cardiology conditions and procedures. It allows the insurer to understand the exact condition of the patient. So, when there is instruction on codes like ‘code also,’ use additional code,’ or ‘code first,’ use them to give a clearer picture to the insurer. However, avoid doing it unless there is any instruction for reporting additional coding for signs and symptoms. Assigning other codes for any associated disease symptoms and signs is unnecessary, especially when there is a confirmed diagnosis and a related code for that diagnosis. Using symptom codes can lead to low or zero reimbursements with claim denials and rejections.
4. Highest Specificity
Cardiologist billers must remember that while coding for any disease, procedure, or service, it is essential to document the diagnosis and code it to the highest degree of specificity. Since there are different codes for different diagnoses, failing to code to the highest degree of specificity would impact how the service is graded or reimbursed. It also needs to make the appropriate risk adjustment to the insurance company, which might affect the practice’s revenue. Accurate coding with complete documentation will give the insurance company less room for translation and finding coding errors like mismatched procedure codes with the diagnosis.
A cardiology biller must consider the comorbidities of the patient. It allows the payer to understand the complexity of the patient’s condition and estimate the expected payment required for the patient. For instance, a patient treated for congestive heart failure and anemia would require billing documentation that mentions the anemia and the cardiology procedure he undergoes. Citing the relevant comorbidities, including the diagnosis codes, must be carefully taken into account while submitting the claims to the insurance company to receive a higher care cost in the form of reimbursements.
6. Billing Software
There is different cardiology billing software, and in this competitive era, finding the billing system that aligns with your cardiology practice is of utmost importance. Investing and learning to work with the latest PMS and EMR that is HIPAA compliant will make the cardiology billing work easy while decreasing the scope of errors and increasing the cardiology practice revenues. In fact, the software has an appropriate claim management system and analytics to work on issues that can cause claim denials.
Choose the Right Cardiology Billing Partner!
The best viable option to avoid errors in cardiology billing is to partner with an experienced cardiology biller. A partner like 24/7 Medical Billing Services can offer quality cardiology coding and billing service that will reduce the cardiology practice’s billing workload and improve the turn-around time. The billing team stays updated as per the latest regulations and updates on coding and billing changes. Furthermore, by working with an experienced cardiology billing partner, you will decrease the chances of claim denials and improve the revenue as you do not have to worry about overhead costs.