Cardiology medical billing is highly rewarding but the path to mastering the revenue cycle requires a combination of technical knowledge and hands on experience. Patient details such as the length of stay, resource utilization, and morbidity have always been critical aspects of cardiology medical billing. The need for detailed specificity both in the documentation and codes makes cardiovascular coding more challenging. Also, when you add the changing CMS regulations, new policies of the private insurance payers, and new regulations of state agencies, the process for cardiology medical billing and coding becomes that much more complex.
But as a cardiologist, you are already aware of these challenges. So, what can you do to improve the cardiology medical billing process?
Here are six cardiology medical billing and coding tips that will boost your practice revenues and improve patient satisfaction.
1. Improve your first time right (FTR) coding percentage.
What is your coding FTR percentage as of today? Measuring your as-is performance is the first step for improving cardiology medical coding accuracy.
Cardiology medical billing often involves using multiple codes simultaneously, and correctly entering the 5 to 7-digit ICD-10 and CPT codes is a challenge. Here’s what you can do to improve your FTR coding percentage:
• Introduce a system of double-checking for the coding entered by your staff.
• Ensure that your billing staff has the updated ICD-10 CM and PCS, CPT, and HCPCS code books handy.
• Subscribe to the AHA (American Heart Association) newsletter to stay on track of cardiology medical billing changes.
• Use medical billing software that updates the latest ICD-10 codes in real-time.
• Monitor the CMS website for medical coding updates.
• Subscribe to the newsletters/ publications offered by OIG (Office of the Inspector General) and state and local agencies that regulate cardiology medical billing practices.
• A simple but vital step is to check the ‘Alphabetic Index’ and ‘Tabular List’ when locating and assigning a code.
• Document to the highest degree of specificity. For instance, systolic versus diastolic heart failure have different codes and reimbursement rates.
Tip- You may be interested in an upcoming webinar by the American Academy of Professional Coders (AAPC) called – Coding & Billing for Services During the COVID-19 Public Health Emergency Era. Date May 25, 2021
2. Be judicious in symptom coding.
It may sound a bit contradictory to the previous point, but it is advisable to report only confirmed diagnosis. The 2019 ICD-10-CM Official Guidelines for Coding and Reporting (Section I.B) recommends reporting only signs and symptoms not routinely associated with the disease process. Assign additional codes for signs and symptoms typically associated with a disease only when there is an instruction specific to that code.
3. Report comorbid conditions for accurate payer estimates.
A patient with congestive heart failure may also have comorbid conditions such as COPD, anemia, or arthritis. Coding the comorbidities indicates the additional health conditions the patient may have and helps the payer make a better estimate for the expected costs.
4. Bill total time spent on the date of service.
As per the Jan. 1, 2021, revised E/M guidelines, the CPT code for outpatient patient visits must be chosen basis the total time spent with the patient on the date of service. It can include the following activities:
· Preparing to see the patient (e.g., review of test results).
· Obtaining and reviewing a separately obtained history.
· Performing a medically appropriate examination and evaluation.
· Counseling and educating the patient/family/caregiver.
Tip: For more detailed information, read the “Outpatient Billing Changes For 2021 – Cardiology Clinic and Beyond” by the American College of Cardiology.
5. Conduct regular documentation audits at your medical practice.
Is your staff capable of creating documentation that correctly depicts a patient’s level of acuity and general health? Are there gaps in documenting medical billing components such as the involvement of an interventional cardiologist, bifurcation interventions, or the use of additional medicines? Documentation lapses in coding and claims submission will decrease billable expense reimbursements and create potential red flags during compliance audits.
Regular documentation audits will help you identify (a) the recurring billing and documentation errors conducted by the staff and (b) the training requirements of your medical coding staff. Cardiology medical billing audits can be done as retrospective or concurrent audits and can be performed internally or by an external audit firm.
Tip – One way to improve accuracy in the documentation at your cardiology practice is to facilitate communication between your team of physicians, nurses, CDI, coders, and billers. Fortnightly or monthly meetings are a good opportunity for your medical billing and coding staff to ask questions (for example, on diagnosis, procedures, supplies used, etc.) and improve their understanding of patient acuity and care.
6. Implement ‘administrative’ patient care strategies.
As per a 2019 paper published in the Journal of the American College of Cardiology, over 45 percent of adult atherosclerotic cardiovascular disease (ASCVD) patients suffer financial hardship related to their medical bills. As a medical practice, you can improve the payment experience for your patients by implementing the following-
• Implement a dynamic patient portal.
• Ensure accurate patient insurance eligibility before visit/procedure.
• Offer repayment plans for eligible patients.
Over the last few years, cardiology practices’ revenue cycle management challenges have increased due to reduced Medicare and Medicaid reimbursements and higher patient payment responsibilities. Many cardiologists have opted to outsource the complex tasks of medical coding, billing, and patient collections.
For information on how working with a medical billing service can optimize your medical billing, book a free consultation with our cardiology medical coding/billing experts.