Cardiology is one of those specialties that generally perform high-cost diagnostic and curative services. Getting reimbursed for such significant services means conclusive and convincing cardiology medical billing – adhering to cardiology codes, compliance standards and coding rules. Cardiologist, who used to be comfortable with a fewer codes and compliance standards and coding rules, are now required to be abreast with period changes in cardiology codes, compliance standards and coding rules. Amongst these evolving changes, cardiologists need to be aware of acceptability of the codes assigned, modifiers to be attached, medical necessity of performing and coding a procedure, component coding, and so on.
In certain cases, insurance payors may contest the medical necessity of certain procedures undertaken by cardiologists. Therefore, it crucial that cardiologists substantiate the necessity of those procedures, otherwise, reimbursements for those procedures may be rejected for lack of sufficient proof.
Identifying Cardiology Billing Challenges
A look at the Medicare rate changes for 2013 (implemented by CMS) explains the panic or rush to billing and coding issues by cardiology centers across the U.S. The new fee proposal discourages administration of multiple cardiology procedures to a patient in a day so that if a patient is provided with more than one cardiology service in a day, the technical component of the less expensive service will be reduced by 25 percent. CMS has kept diagnostic and therapeutic cardiology services in this reductive ambit and left out several other service types. The challenge it gives billers and coders is that they have to be able to separate therapeutic and diagnostic cardiology procedures from other ones and assign appropriate codes.
This may not sound difficult to an uninitiated person; but being a complex treatment with overlapping procedures, cardiology has never been an easy line of treatment to translate into foolproof insurance claims. This problem which will become more biting now given that a biller and coder have to combine a nuanced knowledge of cardiology procedures with sound knowledge of billing and coding, failing which may result in submission of inaccurate claims leading to shrinkage of revenue returns.
CBS and its experienced billing staff are very well versed in today’s Cardiology guidelines and coding issues keeping many from receiving the revenue any Cardiology professionals deserve. CBS medical billers have a driven focus to keep up-to-date on the various changes affecting cardiology procedures in the office and/or in a facility setting.