Tackle Your Cardiology Billing Denials Like a Pro with Sunknowledge

A report by the Healthcare Information and Management Systems Society (HIMSS) reveals that over 70% of healthcare leaders consider claim denials a primary cause of revenue loss. For practitioners in the very demanding field of Cardiology, claim denials can be a nightmare. The complexity of the coding and paperwork, the large number of patients, and the broad range of treatments make Cardiology billing quite taxing for the providers.

When a claim gets denied, you have already spent nearly two weeks on the process.

Appealing against a denied claim requires additional time, money, and resources, further delaying accurate reimbursements. With more insurance companies imposing stricter eligibility criteria for prior authorization and claim submission, Cardiology billing denials have become a prevalent issue in revenue cycle management.

Reasons for Claim Denials in Cardiology Billing

Claim denials can result from even a minor mistake within the billing or coding process. Furthermore, Cardiology being a specialty practice area, it entails complex billing requirements.

Some of the major causes of claim denials are-

• Inaccurate or incomplete documentation
• Illegible handwriting if claims are manually submitted
• Incorrect coding
• Missing or inaccurate modifiers and combination codes
• Lack of prior authorization

How to Prevent Cardiology Billing Denials

The Medical Group Management Association (MGMA) states that a practice must have a clean claim record of 95% or greater. Surprisingly, most practices find it difficult to get a clean percentage higher than 75%. Now, even a small practice filing 2,000 claims would result in 200 refused claims at a 10% denial rate! Reworking a claim might cost anywhere between $10 and $25, which adds up for these 200 claims!

Considering how complicated these problems are, you should move quickly to solve the main problems. We’ve included five recommendations to assist you in recognizing where things could go wrong.

1. Check eligibility information: Whether you are rendering service to returning patients or registering new clients, it is essential to verify the patient’s eligibility and benefits each time.

Pay attention to:

• Pre-existing conditions
• Lifetime benefit cap
• Change of employer or insurance plans
• Whether your facility is listed as in-network or out of network provider
• Which cardiac tests and procedures are not covered within the plan

2. Ensure correct patient information: Most mistakes start during patient data intake. Avoid entering incorrect patient information and always double-check their personal and medical information. Managing patient files can be challenging considering the increasing cardiac patient volume; there are chances of misplacing information. You can consider using the EHR to handle humongous patient data.

3. Reduce coding errors: Accurate coding plays an important part in efficient Cardiology billing and claim denial reduction. Entering incorrect or deleted codes, up-coding, under-coding, and frequent changes within CPT codes make the process more difficult. Only twice a year can codes such as 93880 (non-invasive cerebrovascular arterial investigation) be billed. It is not possible to utilize 93297 and 93295 together. Consult the most recent editions of the CPT, HCPCS, and ICD-10 CM and PCS code books to reduce coding errors. To remain up to speed on the latest news and updates, subscribe to the American Heart Association’s (AHA) weekly email. Furthermore, you ought to frequently inquire about updates from the CMS and regional regulatory agencies.

4. Obtain prior authorization: It might be challenging to ascertain whether tests and procedures require pre-auth from insurers, according to nearly 64% of doctors. Many cardiologists who disregard the pre-auth requirements lose out on the settlement of their claim(s). Preauthorization is necessary for various cardiac procedures and tests, such as “pacemaker installation,” “electrophysiologic,” and/or implantation of hemodynamic monitors. Get a preauthorization from the insurance company before rendering the services.

5. Avoid late filing: Billers must ensure their claims are accepted to comply with the deadline for timely filing. A claim can be turned down at any point, and by the time it reaches your desk again, half the time has passed. Keep in mind that your payer will only consider your claim if it is filed far in advance of the deadline and includes all required components for processing.

Learn the following best practices to ensure that your claims are filed on time and prevent denials:

• Verify the payer-specific timely filing limitations whenever submitting claims
• Submit new claims daily
• Before the deadline, the appeal rejected or refused the claims
• To prevent late filing, use software for electronic claim submission

Finding the Right Billing Partner

If you are thinking about outsourcing, you should not make this choice hastily. There are many businesses out there, and conducting research for a cardiology office may take longer than for other types of medical operations. This is due to intricacies in Cardiology billing and coding processes.

We deeply know the marketplace and have resources specialized in Cardiology revenue cycle management. For more than a decade we have been providing excellent solutions for cardiologists, helping them reduce claim denials and revenue generation. For more information on how partnering with us can make a difference, contact us today!