Cardiology practices are no strangers to auditing. The cardiology practice has a multitude of different factors and units for billing. The practice of cardiology encompasses a wide array of medical services that makes it a necessity for professionals who practice cardiology to completely document each and every billable procedure or interaction with the patient.
Medical billing is an objective method of calculating the expenses for medical service provided by a medical professional. There are several factors that would affect the billing units.
Factors include complications based on the patient’s current state before being examined by a medical professional. A patient’s current state affects the level of skill and expertise required of a medical practitioner to assess and attend to the patient’s condition.[/vc_column_text][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column]
Challenges for Cardiology Billing
[vc_column_text]Cardiology billing is inclusive of all practices related to cardiology, including procedural and diagnostic services. An accurate documentation of all the procedures performed and all diagnostic services attended to is required to make a convincing and conclusive cardiology billing.
Accurate documentation requires a working knowledge of cardiology codes, coding rules, and compliance standards.
In some situations, Insurance companies challenge the judgment of a cardiologist for making a procedure necessary. Therefore, it’s imperative for cardiologists to provide an up to date, accurate report on the patient’s current condition to thwart suspicion.
Disproving medical opinion is relatively simple if there are no supporting facts to the claim, and compensation for the procedures performed may be declined due to the lack of the necessary proof to validate a cardiologist’s call.[/vc_column_text]
Medicare Rate Changes in 2013
[vc_column_text]Cardiology billing has undergone a major overhaul that Centers for Medicare and Medicaid Services (CMS) implemented. The coding changes for cardiology billing makes it more complex for coders to accurately code a procedure done by a cardiologist in one day.
Since cardiology is a practice that may require several interconnected procedures with one patient in a day, it has become a challenge for coders to effectively input the necessary codes. If a patient is provided several cardiovascular procedures done in a day it makes the technical component of a less expensive procedure reduced by around 25 percent.
The changes made by Medicare for cardiology billing codes make it also a challenge for coders to effectively separate the values for therapeutic and diagnostic procedures for cardiology. The Centers for Medicare and Medicaid Services have a reductive scope for therapeutic and diagnostic cardiology services and these changes have left out several service types.
This is an issue that MPMR has experts to deal with, and has been working with cardiologists for a very long time to maximize appropriate reimbursements. While working with MPMR, you can rest assured that your cardiology medical billing is being handled by expert Certified Coders and Billers.
Prevent Reduction in Revenue
[vc_column_text]An inaccurate cardiovascular billing procedure may lead to a very steep shrinkage of revenue returns. After all, cardiovascular procedures and diagnostic services are rarely a simple line of treatment that can easily be justified.
Cardiovascular treatments may require a specialized and complex procedure that may overlap, and this may effectively flip the red flags off of an insurance company’s filters.
Insurance companies often times require a justification from the medical services provider that they were present during the time that the patient was being treated, either through a procedure, or through diagnostic services.
Overlapping through two different procedures occurring at the same time, administered by the same medical services provider may lead to questioning. Effective documentation and a well-justified explanation about the procedure and the timeframe selected to perform the said procedures are keys to making a justified claim.
MPMR will be able to walk you through the effective and appropriate ways to document cardiology procedures.[/vc_column_text]
[vc_column_text]In cardiovascular billing, or any other billing practices, it’s imperative for medical coders and billing agents to create a detailed documentation to justify a cardiologists’ decision in a situation. Always account for every service done and justify the need for every procedure performed on a patient. After all, an auditor’s job is to figure out if the funds are used properly, and that the system is protected against fraud and misuse.
[/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_column_text]For two decades, MPMR has been working with cardiology and specialty medical practices nationwide on medical billing, credentialing, contracting and practice management to maximize revenue and increase efficiencies.
Call today for a free consultation to see how MPMR is the perfect partner for your practice![/vc_column_text][/vc_column][/vc_row]