Things You Should Know About Cardiology Billing

Cardiology billing and coding are complex for several reasons. Cardiologists regularly experience changes in key procedural rules, complex contractual adjustments, and changes in coding regulations. Furthermore, a wide range of modifiers used within Cardiology billing processes is a major challenge for providers.

Cardiology Billing and Coding Pain Points

There seem to be three major categories that constitute the largest share of denied claims. First, a lack of accurate documentation, followed by changing payer guidelines and coding requirements. In an industry like healthcare, with its complex payment systems, changes are inevitable, and practices need to position themselves to respond proactively and effectively.

1. Documentation challenges: Documentation is uniquely controlled within the healthcare practices. Your records are only as accurate as the information entered. Being a specialty practice, you deal with referring providers who may or may not have provided accurate documents.

Incidentally, a study has identified only 38.5% of the systems reviewed had matched actual patient requirements. Likewise, coding and revenue capture suffer from documentation errors.

2. Billable diagnosis coding: Staying updated about diagnosis coding and procedural coding is necessary to obtain accurate reimbursements. Also, if you do not understand the applicability of the codes then there are chances of erroneous billing.

Furthermore, the Cardiology sphere has faced several coding changes this year. And it is hard to cope with the changes when you are already burdened with clinical responsibilities.

For instance, 12 new CPT codes were developed for the phrenic nerve stimulator system to treat central sleep apnea. Eight CPT codes (33277-33288) were developed for the insertion, removal, and replacement of the phrenic nerve stimulator. These codes include vessel catheterization, all imaging guidance, and interrogation and programming when performed. One new code was created for therapy activation of the implanted phrenic nerve stimulator system (93150) to be performed on another day. Two new codes were developed for the interrogation and programming of an implanted phrenic nerve stimulator (93151 and 93152) and one new code for interrogation without programming (93153).

3. Ever-evolving payer policies: Apart from coding-specific challenges, the payer-specific rules and guidelines pose a roadblock in Cardiology billing. There are over 900 health insurance companies in the US today. While all are not operating in your area, there is a good chance that as a specialty provider, you are contracted with anywhere from 10 to 25 different payers. Their claim submission requirements can be overwhelming due to the intricacies. This might result in erroneous billing and lead to denials and revenue loss.

Another major concern while considering Cardiology billing is a shift in the care process from fee-for-schedule to value-based care. Medicare is looking for a major transition within the care process and thus Cardiology medical billing is transforming.

By 2030, every dollar Medicare pays will be tied with a value-based payment model, which will change the reimbursement processes too. The most common value-based program is now in merit-based incentive payment system (MIPS). Many cardiologists are already performing under this model. As a result, they are struggling with dynamic Cardiology billing and reimbursement requirements.

Choosing the Best Services for Cardiology Billing

Sunknowledge Services Inc. is a leading revenue cycle management organization that specializes in providing comprehensive Cardiology billing and coding solutions. We have been serving both payers and providers with great reference and versatility for more than a decade. From pre- to post-billing, our experts can handle all the administrative tasks.

Our experts are well-versed in different software systems and industry-comprehensive coding and billing regulations. They can work as an extended operational arm for your practice and navigate your ROI in a positive direction.

Only with Sunknowledge you can have-

• 99.9% accuracy within medical billing and coding processes
• Reduction of overhead costs by 80% almost immediately
• Constant communication with all the stakeholders
• Constant monitoring of the submitted claims to stay updated
• 100% HIPAA compliance
• Accurate claim submission and efficient denial management

Get in touch with us to know more about how we set the perfect standard to optimize your growth most definitively. Talk to one of our experts to discover why we are hailed as the best virtual assistants in Cardiology billing.