Cardiology is one of the growing disciplines over the years. The advancement in treatments, medical procedures, diagnostic tools, and therapies for cardiology announced regularly has made it a complex field to go about. However, with these quick and rapid developmental changes in billing and coding, lacking behind to keep pace has become a common practice.
However, cardiology medical billing guidelines with the new ICD-10 implications need accurate claim filing and documentation to obtain consistent and complete timely reimbursement. No matter, whether your revenue management process for handling billing coding operations is handled in house it is outsourced, they can be simply affected by;
- The lack of information about the updated ICD 10 PCS, ICD 10 CM, HCPCS, and ICD 10 codes
- Human error
- Lack of expertise in using modifiers and codes
- Under-coding or up-coding medical proceedings
Not only is it needed to have complete information about the coding and modifiers but to use them accurately is the essential element of timely reimbursement and successfully getting paid for the services provided. Here in the following, cardiology medical billing guidelines are discussed to help you get your billing goals successfully.
Cardiology Medical Billing Guidelines
- Get informed by the updated guidelines for coding regularly
Coding guidelines are often available in the form of booklets other than on an online portal. These booklets should be on the tables at the clinic to get references for ICD 10, HCPCS, ICD 10 CM, PCS, or CPT codes. With the annual revision in the codes and guidelines, these booklets should be revised with the newly published edition.
In addition, the staff should also be synchronized with the latest updates for cardiology medical billing guidelines 2022.
Also, it would be helpful to subscribe to the updates through newsletters with the organizations that manage coding and billing guidelines such as the American Heart Association (AHA), the Office of Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS), etc.
- Avoid coding for symptoms, bill for diagnosis instead
Professionals in billing and coding suggest not to code against a symptom, but instead bill for the confirmed diagnosis along with the procedure that has been carried out for the treatment of the particular ailment. For instance, for a cardiology patient, you should code for myocardial infarction (a diagnosis) instead of coding for chest pain (symptom).
Also, avoid using symptoms that already are associated with the main diagnosis unless a specific code suggests it. However, if the symptoms are not linked with the associated disorder, it is recommended by the experts to add them to the claim. By doing this, the payer will have an idea of any recurring disorder or possible disorders that would affect the patient’s health in future.
- Audit your finances regularly
When a company practices regular audits, it gets simpler to get a hold of errors and repeated mistakes. Auditing helps identify the areas where your billing team is lacking behind, its shortcomings, and enables you to analyze the expertise of your team. Also, awareness created through audits eventually diminished the chances of billing and coding mistakes.
Conducting regular audits elevates the communication between medical staff including, billers, coders, providers, nurses, and auditors. Also, this will allow discussion over improving quality of the patient care and prioritizing it to another level.
High documentation and auditing will improve the quality of the claims overall and identify the shortcomings of errors. When audits are performed, chances are there that they will reveal mistakes that commonly become the reasons for your claim denials and you can rectify them before submitting claims in the future.
- Identify human errors and mistakes
Cardiology coding becomes tricky for coders after every update, which leads to minor and major errors along the process. These mistakes and errors become the most common reasons for claim rejections and claim denials when it comes to medical billing.
For instance, if a coder has been working in the cardiology field but with any other speciality, then it gets simple to mix up the codes while coding for another field. It of course may not happen deliberately, when these digital codes are added manually, these 5 to 7-number code errors happen normally.
These error-prone practices can be eliminated if you introduce a double-checking system for codes while compiling claims. The practice will increase the accuracy of bills before they get audited. Although these practices are time-consuming and this may delay the process as well, to cut the duration, you can also take help from a cardiology medical billing software that will automatically populate the codes for diagnosis and diseases. The software integration will not only reduce the chances of errors but also expedite the process.
- Use combination codes and be specific about them
As mentioned, coding errors will cause claim denials which often leads to inconsistent audits. Insurance companies will only accept the claims and reimburse the amount if the documentation of the healthcare services provided is accurate. Therefore, to get paid for the services and manage a smooth revenue management cycle it is vital to submit complete claim documents.
Make sure that you have documented everything. For example, if you have cardiac catheterization performed but not documented, then the lack of verification will not get you reimbursed. Also, if the equipment or supplies have been used in the procedure, without mentioning or verifying they will not be accounted for reimbursement.
On diagnosis and coding, the combination of codes is also important when billing the thorough diagnosis of patients. This means when a patient arrives at practice, there may be more than one medical condition that they have come up with that you need to code for. For instance, if a patient comes up with a heart disease having acute pain in his lungs due to pulmonary function failure, both codes should be used in the bill as they both are diagnoses and approved diseases.
This is necessary because healthcare institutions are paid on the basis of diagnosis and procedures. The use of accurate codes in claims will guarantee complete returns.
- Hiring trained professionals
It is no brainer that cardiology medical billing and coding demands skilled and experienced professionals. Proficient coders must be able to understand the hidden nuances of codes, comprehend the modifiers and disqualifiers in the codes, and be able to utilize the knowledge within hospital situations.
For this and for many other reasons, it is important to employ experienced cardiac coders and billers and keep your staff members informed of the client-specific billing guidelines. It is also vital to make sure that your staff members are highly up to date according to any revisions and guidelines for cardiology coding regarding ICD 10 PCS, ICD 10 CMS, HCPCS, and CPT.
- Use billing and coding software
Although cardiology is a crucial field and complex, crucial changes in coding procedures keep happening. With this, it poses a great responsibility on the coders and billers to document every narration with patient health that needs to be accurate in terms of coding.
Physical records where the documents need space to be piled up and stored are not efficient when they are compared to electronic maintenance of health records. This is why using EHR, identifies clinical documentation which is correct and organized. Plus, medical billing software like EHR, automatically updates the coding guidelines so you don’t need to worry about going through the booklet and referencing the code before adding them manually which increases the risk of errors.
What you should do to optimize your cardiology billing and coding?
Submitting claims with accurate coding and billing is necessary for the timely reimbursement of healthcare institutions. Correct coding enables consistent audits, faster reimbursements, and smooth revenue cycle management.
Adhering to the mentioned guidelines will help you increase your cardiology medical billing accuracies which eventually leads to successful practice management.
To optimize coding and billing procedures, a few elements are necessary to act upon. This includes highly trained staff, accurate comprehension of diagnostic tools, periodic audits, and technological integration. To get a hold on every element, outsourcing your medical coding and billing processes will probably be your safest option.
Medical billing and coding outsourcing companies are equipped with updated knowledge of codes and cardiology coding and billing guidelines shared regularly. They have experts in this medical field which not only saves you time from dealing with codes for claim submission but also money that you would put into hiring a team of professionals to work in-house.
These professionals are trained, experienced, and reliable to handle your data more accurately. This ensures that your data is definitely in safe hands and your practice will be reimbursed with less to no coding errors and top-notch revenue management service.