The Significance of Responding to Cardiology Billing and Coding Dynamics

Cardiology is one those specialties that generally perform high-cost diagnostic and curative services, and 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.

Acceptability of the codes assigned

Contrary to overlapping cardiology codes in the past, CMS has comes up with an exhaustive list of cardiology codes, meaning virtually an independent and appropriate code for every cardiology procedure. Therefore, Medicare, Medicaid, and private insurance companies can easily verify and ascertain whether or not you have aptly coded your procedures. Moreover, attaching a lower-paying code for a relatively costlier procedure does not make sense at all.

Apart from learning evolving coding numbers and their correct assignment, cardiologists should also familiar with changes that have been introduced in codes relevant to heart catheterization, revascularization, observation services and more. Many existing codes have undergone revisions, including iliac repair, angioplasty, non-coronary stent placement, wearable ECG recording, and non-invasive physiologic changes. As of now, while billing for cardiology procedures:

• Cardiologists are required report most non-congenital procedures with a single code
• Catheterization coded for non-congenital studies cover injections, imaging supervision, interpretation and report.
• Imaging supervision, interpretation and report are included with the injection procedure and cannot be reported separately in the case of all cardiac catheterization procedures
• Cardiology-specific codes such as 93451, 93456, and 93503 are not allowed to be attached with modifier 51.

Medical necessity of performing and medical necessity of performing and coding a procedure

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 that have sent coded. Otherwise, reimbursements for those procedures may be rejected for lack of sufficient proof.

Component Coding 

 

Cardiologists’ services may often involve certain technical components, and there are specific coding ruling depending on the criticality of each of such technical components. A higher technical component should always be accompanied by a higher value code so as to maximize the eventual reimbursement. In cases where there are several technical components involved on the same, the lowest component should be singled out to prevent the mandatory 25 percent deduction being charged to any other higher paying technical components.

All of these evolving cardiology codes, standards, and rules may limit cardiologists’ ability to realize their reimbursement in full. Therefore, irrespective of you being interventional cardiologists, diagnostic cardiologists, electro-physiologists, nuclear cardiologists or cardiovascular/ cardiothoracic physicians, you may eventually need an effective revenue cycle management solution in place that is integrated with the right technology, processes and people to respond to Cardiology Billing and Coding dynamics.

Medicalbillersandcoders.com offers and mediates resource deployment for integrated solutions in medical billing Revenue Cycle Management to diverse medical practices across the 50 states in the U.S. Our capability in cardiology medical billing is driven by a nation-wide resource base of expert cardiology medical billers and coders familiar with cardiology-specific medical billing, technology, and processes. With access to such talent-pool of professionals, cardiologists across the U.S. should be able to respond to cardiology billing and coding dynamics.

Ascertaining Cardiologists’ Medical Billing Needs Even as They Migrate From Private Practices to Hospitals

Till recently, cardiologists who were happy with their private practices have suddenly started exploring avenues to align themselves with hospitals. The change has been so dramatic that already around 15 percent of cardiologists across the U.S. have left their private practices in search of more secure positions in large clinics and hospitals. As per reliable industry sources, the exodus might well cross 70 percent in a couple of years. This shift may have not come about without valid reasons – increased regulations on private practices, stricter reimbursement environment, and a series of healthcare reforms calling for healthcare to be made more affordable may have triggered the swift turn of events.

Impact of revised cardiology fee schedules Like in other clinical disciplines, cardiologists too are feeling the heat of significant cuts in their fee schedules. The recent revision to cardiology fee schedule is so hard on cardiologists that it is virtually difficult even to operate on minimal operational margins. While a certain double digit cut to reimbursement from Medicare is expected, there is also apprehension that private payors may also follow suit. The consolation from the likely swell in patient numbers may not still be able to off-set revenues losses completely.

Stricter federal regulations on private practices Although the recent health care reforms are generally aimed at optimizing the quality of medical care across the nation, private practices may feel rules and regulation emanating from such reforms to be rather harsh or difficult to comply with. Affordable care model, mandatory EHR compliance, and the ensuing ICD-10 billing regime may be both exhausting and expensive. Therefore, cardiologists in private practice may deem it apt to mitigate such burden by abandoning their private practices, and practice in hospitals where they focus solely on cardiology efficiency.

Lure of hospitals Certain hospitals too are laying out baits to cardiologists with promise of lucrative benefits and vertical promotions. Hospitals feel that they can improve the quality with a large pool of experts under one umbrella. And, as for the cardiologists, it may be an opportunity to expand their professional expertise without additional overheads.

Immunity from administration burden One of the significant reasons behind cardiologists opting for larger clinics and hospitals is the perceived burden of administration, which is likely to be even more laborious in the aftermath of the recent health care reforms and the ensuing ICD-10 billing regime

While this migration may clinically and operationally be prudent for cardiologists who do not want to risk practicing amidst volatile conditions, it may not be good for the industry which has always thrived on proper mix of sole practitioners, clinics, and large cardiology specialty hospitals. The fear with this unprecedented exodus is that it may deprive instant access to primary cardiology points. Therefore, cardiologists need to be assured of operationally viable practices. And, there is no better way of doing this than easing cardiology medical billing burden of their shoulders.

Medicalbillersandcoders.com has been a premier source for medical billing, coding, and revenue cycle management services. Practices of varied sizes and disciplines across the 50 states in the U.S. have found our services to be reassuring at times of major operational dilemma. And, now at a time, when cardiologist across the U.S. are losing faith in private practices, our cardiology-specific billing, coding, and RCM solutions may just help them focus on their clinical priorities without being unduly worried about operational issues.