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6 ways to overcome cardiology billing challenges!

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Cardiology is a specialty that sees rapid development in technology and cardiovascular procedures. There should be no knowledge deficit regarding ICD-/CPT codes for claims to be reimbursed, as it is accurate coding that gets physicians paid. There are other challenges in cardiology billing and coding, such as documentation not up to standard, human errors and not using combination codes correctly.

To have a successful cardiology revenue cycle and to overcome billing challenges, the following six ways will help.

  1. 1. Continuous Education (knowledge on coding changes)

ICD-10 and CPT codes undergo changes regularly. The medical billing and coding team must always be on top of these changes. Modifiers are one of the critical components in medical coding. If there are errors in using modifiers, it will impact your revenue and may result in compliance issues. The billing team must also be knowledgeable about rules and regulations related to cardiology. Staff education is therefore essential to keep the billing and coding team stay current.

2. Using combo codes

ICD-10-CM has several combination codes for cardiology conditions. The billing team must be aware of these codes and use them appropriately to describe the patient’s condition correctly. Cardiology coders need to know and follow various coding instructions such as “Code also,” Use additional codes,” “Code first” to give a complete picture and avoid denials by payors.

3. Complete and accurate documentation required

To ensure full payment of your cardiology claims, it is vital that documentation be complete and accurate. Incomplete documentation will quite likely result in missing codes and thus loss of revenue to the practice.

In the case of procedures, documentation gaps for cardiac catheterization may lead to the loss of potential codes / codable components. This includes bifurcation interventions versus branch interventions, supplies used and additional medications used outside of the “standard.” Also, changes in the anticipated procedure may arise due to the actual condition of the patient. Hence accurate documentation is needed in cardiology.

The billing team will have to grapple with these issues leading to delay in submitting claims and quality billing service. Compliance issues may also arise with incomplete documentation.

4. Focus to be on diagnosis, not symptoms

In cardiology billing, coding should be done only for diagnosis when a diagnosis is confirmed. Coding for symptoms associated with a disease must be avoided. However, symptoms usually not associated with an illness may be reported according to ICD-10 official guidelines.

5. Coding comorbidities

Comorbidities are relevant health conditions documented by the physician. Coding comorbidities will ensure that the physician gets higher reimbursement. Documenting comorbidities helps to show the complexity of the case. Suppose the cardiologist is treating a patient with congestive heart failure. In that case, the documentation will show that the physician had to factor the patient’s COPD, anemia, or arthritis into the patient’s treatment. Coding the comorbidities lets the payor know the patient’s additional conditions so the payor can estimate the patient’s expected costs.

6. Audit frequently

Regular internal and external audits will reveal common coding and documentation errors. It will show up areas where staff need to be trained. An open communication channel between physicians and the billing team is a necessity for successful revenue cycle management.

Regular staff education, proper documentation and adopting good coding practices will result in a faster reimbursement, fewer external audits, and overall improved compliance. As multiple parties are involved in painting an accurate picture of the patient’s comprehensive care and acuity level, frequent audits will ensure correct documentation and consistent cash flow.

Bristol Healthcare Services, a leading medical billing and coding company, will assist you with your cardiology billing and coding. Leave all the back-office challenges to us. We have been serving physicians for over twenty years, helping them increase their revenue and expand their practice.

Partner with us for a mutually rewarding relationship!