Improve Cardiac Monitoring With Cardiology Billing Services

Cardiologists cannot disagree with the fact that cardiovascular diseases are among the leading causes of illness around the world. Treating patients involves various kinds of procedures, medications, and equipment. This also suggests that the reimbursement process for these services will have different policies and rules. You have to ensure accuracy in following payer policies, obtaining prior authorization, and timely claim submission. One of the most critical aspects of cardiology is cardiac monitoring. Submitting claims for this service is quite challenging, because of which many providers hire professional cardiology billing services.

As a cardiologist, you would not like to witness your claim denials and revenue leakage in your practice. Cardiac monitoring involves continuous recording and patient management for several weeks. The billing codes are different for different types of monitoring which your in-house staff may not be aware of. Even though you are providing the best quality of care to patients, the reimbursement may not do justice to your service. A cardiology medical billing company can put you on the right track and streamline your finances in the best possible way.

What makes cardiac monitoring critical in cardiology practices?

It is noticed that almost every cardiac care center uses cardiac monitoring for patients who undergo treatment. With millions of people being affected by cardiovascular diseases, the demand for accurate and timely cardiac monitoring is increasing. In fact, here is why providers use the application of this cardiovascular monitoring method to treat patients.

Helps detect early cardiovascular conditions – One of the primary benefits of cardiac monitoring is its ability to identify abnormal heart rhythms and other potential cardiovascular problems before they become serious. Technologies such as Holter monitors, event monitors, and mobile cardiac telemetry (MCT) help cardiologists collect valuable information about a patient’s heart activity over extended periods.

Supports continuous patient monitoring – Modern monitoring technologies allow cardiologists to observe patients’ heart activity beyond traditional hospital settings. Wearables, be it ECG devices, wireless monitoring systems or even remote cardiac monitoring solutions, enable patients to undergo monitoring at home while healthcare professionals review relevant data.

Helps prevent cardiovascular complications – Heart rhythm abnormalities and changes in cardiac function can easily be identified with continuous and periodic heart function monitoring. Cardiologists can easily detect atrial fibrillation, which helps determine appropriate treatment.

Improved diagnosis – Physicians can have detailed information about heart rhythm patterns that may be missing during a routine ECG examination. This helps cardiologists recommend Holter monitoring or routine electrocardiograms (ECG) depending on the patient’s condition.

When you look at all these benefits of cardiac monitoring, you may think about billing complications. Payers may have different reimbursement policies, and codes may change, making it more difficult for you to get proper reimbursement. This brings us to the challenges often faced by cardiology clinics in cardiac monitoring billing.

Related Reading: Why Cardiac Implant Claims Require a Cardiology Billing Company

4 Major reasons why reimbursement is a challenging task in cardiac monitoring

You may have years of experience in applying heart rate monitoring for patient treatment. However, when it comes to reimbursement, it is a different game altogether. Providers often face challenges in getting accurate reimbursement, which include the following:

Differentiating between technical and professional component billing – This is one of the major reasons why your practice is struggling to maximize revenue. The technical component includes equipment, monitoring, and analysis of recorded ECG data. The professional component includes the interpretation and reporting services offered by the physician.

• CPT 93229 is used to represent a technical component of mobile cardiac telemetry
• CPT 93228 is used to professional interpretation and report for mobile cardiac telemetry

When different entities perform these services, billing coordination becomes essential. Submitting duplicate charges or incorrectly reporting professional and technical services can trigger payer edits and reimbursement issues.

Monitoring duration and date-of-service errors – Cardiac care usually involves treating patients for several days or weeks. As a result, the use of cardiac monitoring also extends for a significant time period which makes date-of-service reporting particularly challenging. For example, a Holter monitor may record heart activity for 24–48 hours, while extended ambulatory monitoring and mobile cardiac telemetry can involve longer monitoring periods. Incorrect reporting of monitoring duration or dates can result in claim denials and payment discrepancies.

Establishing medical necessity – You may find it easier to explain medical necessity of heart rate monitoring to patients than to insurance companies. Payers generally require sufficient clinical documentation to establish the medical necessity of cardiac monitoring. There are high chances of claim denial if the medical record does not adequately explain the clinical reason for monitoring.

Complex coding – One of the biggest challenges in cardiac monitoring billing is selecting the correct CPT code. Different cardiac monitoring services have different coding requirements depending on the technology used, recording duration, and services performed.

In most cases, the in-house teams are not experienced in handling monitoring related codes. As a result, claims are submitted with incorrect codes, claims are rejected, and cash flow is affected. Some of the commonly used CPT codes in cardiology coding are:

• 93224-93227 for Holter monitoring
• 93228-93229 for mobile cardiac telemetry
• 93241-93248 for extended ambulatory ECG monitoring

Hiring professional cardiology billing services can significantly transform these challenges into benefits for providers. For better transparency, you must know how these outsourced companies manage the complexities of cardiology RCM. This will help you understand what you are signing up for.

Related Reading: 5 Questions to Ask a Cardiology Billing Partner before Hiring

The role of professional cardiology billing services in handling cardiac monitoring reimbursement

Before you hire a third-party company, you must think about how your practice can benefit from their services. The complexities of heart rhythm monitoring billing can be streamlined in the following ways:

Better administrative efficiency – Heart rhythm monitoring involves several administrative tasks such as insurance verification, prior authorization, claim submission, and denial management. The in-house team can face issues in handling these tasks, especially the high volume of Holter monitoring. The outsourced billing companies use dedicated billing teams and specialized billing software to reduce administrative burden on the in-house staff.

Accurate coding – Most outsourced companies employ certified coders who have the knowledge and expertise in cardiology-specific coding guidelines. This helps ensure that cardiac monitoring services are accurately coded and submitted for reimbursement. So if you hire an outsourced cardiology billing company, there are more chances for your cardiac monitoring billing to improve within a month.

The professional companies also conduct frequent coding reviews to identify errors before claim submission. This not only reduces the chances of claim denials but also saves time that may have been invested in correcting the denied claims.

Faster claims processing – This is a way in which outsourced cardiology billing services help improve cardiac monitoring reimbursement. Cardiac monitoring procedures involve charge capture, CPT and ICD-10-CM coding, documentation verification, claim scrubbing, submission, and payer follow-up.

The billing team reviews claims for major issues such as:

• Incorrect codes
• Incomplete patient information
• Invalid insurance details
• Documentation errors

A professional billing company identifies these issues before submission, which not only helps avoid claim rejections but also supports a higher clean claim rate.

Now that you know how a professional cardiology billing company can improve cardiac monitoring reimbursement, it is important to understand the factors before hiring an external company. You are not only aiming for improved accuracy but also ensuring that the safety of your patient information is not compromised.

How does SunKnowledge take the complexity out of cardiology billing?

There is one thing that you must always consider before hiring a company for cardiology billing. It is the experience or the expertise of the company to handle cardiology specific reimbursement complexities. SunKnowledge has been providing heart care billing solutions for over 17 years to multiple clients. Apart from offering dedicated account managers and certified coders, we also aim to reduce your AR aging with accurate claim correction methods. Our team members are experienced in all the updated coding rules and different payer policies. This makes it easier for you to streamline overall cardiology revenue cycle management. Do not let your valuable efforts go in vain. Contact our experts and experience the best cardiology billing services.