Cardiology Medical Billing; A step by step Guide to Uncover Loophole in Cardiology Practices

With shifting payment models, innovative digital health technologies, new government mandates, and ICD-10 requirements, Cardiology practices face many challenges in obtaining reimbursement. Error-free Cardiology Medical Billing and Coding are crucial to minimize claim denials and ensure on-time reimbursement for these specialties.

Cardiology is one of the most intriguing specialties in healthcare. According to research, heart disease causes about 655,000 deaths in the United States each year.

What is Cardiology Medical Billing?

Cardiology Medical Billing is identical to many other medical billing systems. However, it is a little more complicated for physicians and billing service providers.

The system works as follows: the patient arrives for treatments, and following pre-authorization by a staff member, the patient receives treatment and pays charges for services.

If he is insured, his insurance company is responsible for paying for the treatment. In addition, the health care provider can seek some help by developing an in-house team to manage billing activities. Alternatively, they can outsource their billing to the top Revenue Cycle Management companies.

Step by Step Process of Cardiology Billing

Here is a step-by-step procedure for Cardiology Billing.

  • Step#1

    The medical practice first requires complete details about the patients. This process is also known as the registration of the patient.
  • Step#2

    The next step is to confirm the insurance eligibility and accountability of the patient.
  • Step#3

    Following the verification process, the medical practice can offer them services as per their insurance.
  • Step#4

    The next step is that you will need to create claims to be reimbursed by the insurance company. Claim creation requires numerous steps like making sure that you use a modifier and error-free coding. Additionally, it also ensures that you adhere to the rules set by HIPAA and other regulatory agencies.
  • Step#5

    Following the adjudication of the person paying, the individual may let the money out or refuse it for various reasons.
  • Step#6

    You must follow up with denied claims once you have found out the reason for the denial. So, to ensure the appropriate reimbursement for the Cardiology service you gave to the patient.

That was a brief overview of how a conventional medical billing system operates. On the other hand, the operation involved in Cardiology Billing is quite similar to the typical medical billing system. However, several medical processes make it harder for providers of services to keep track of all the procedures and modifiers. It increases the chance of errors in the coding process as well as recording. We will examine how we can effectively manage the Revenue Cycle Management process to ensure the maximum amount of reimbursement.

How to effectively manage Cardiology Medical Billing?

It’s crucial to know the basic procedure to manage the entire Cardiology Revenue Cycle Management process successfully. Here are the key actions you should know before submitting a claim.

  • Verify the accuracy of records

In the first step, the accuracy of patient details is vital. Since any error in this phase will cause a significant loss to your practice. There are many claims rejected due to errors within the documents. It is, therefore, crucial to avoid the possibility of mistakes in record-keeping starting from the beginning.

The person who is in charge of your front desk must accurately record all critical information provided by the patient. Name, Social Security number, address, age, demographics as well as information regarding the insurance company of the patient should be accurately recorded.

You must ensure that you are in good communication with the patient. It is helpful to determine the issue at the first stage. Although, better communication can help you better comprehend the entire scenario.

  • Check insurance eligibility

The verification of insurance or eligibility procedure is among the most crucial steps in Cardiology Billing. In the case of Cardiology, many choices must be considered when addressing the patient.

The following steps required a correct diagnosis of the condition, operations, and the use of various kinds of equipment. We can see there are multiple steps when treating a patient who suffers from cardiovascular disease.

On the contrary, there are various services that are generally not included in the general agreement by the company providing insurance.

In the end, the insurance company typically does not cover the services because they’re not included in their agreement. The patients are often unaware of these rules.

The healthcare service provider must verify insurance coverage and eligibility before providing treatment.

  • Using Appropriate Modifiers/Codes

The billing process for Cardiology is a bit difficult compared to other kinds that provide medical care. It requires a professional team who knows the proper usage of the appropriate modifiers and exact coding processes.

Medical codes can be complicated, especially when involved in a Cardiology medical procedure. Aa, it could increase the chance of being inefficient. So, to ensure that it is efficient, it is essential to double-check codes prior to submitting.

Many health companies are well aware that numerous claims have denied by the insurance company because of incorrect modifiers. For a correct billing process, making use of correct modifiers is vital.

  • Make sure your practice is up-to-date

Any practice offering Cardiology services must stay updated with the latest rules and regulations. Be sure to follow the latest ICD-10, CPT, and HCPCS codes.

You can also keep track of the most recent trends and regulations on the CMS website. Furthermore, you can also follow other organizations like the American Heart Association and the Office of the Inspector General (OIG) to ensure that your practice is up-to-date.

Cardiology Medical Billing
Cardiology Medical Billing

Top reasons to Outsource your Cardiology Medical Billing

Cardiovascular disease is among the leading causes of death across the USA. It is a need of the moment to provide top-quality medical facilities for those suffering from heart problems. Conversely, the primary concern for many providers is the rising costs and ineffectively controlling revenue.

It’s not easy to deal with the recent medical reforms. You can hire professionals simultaneously for the billing for Cardiology. There’s a good chance that managing all this will mean that patients’ care may be affected.

Outsourcing is the most efficient method for Cardiology providers. It will not only control their costs but also provide top treatment to patients. Medical professionals have skills and expertise in efficiently managing any billing process.

Why NEO MD is the best platform to outsource your Cardiology Billing?

NEO MD can help you with your Cardiology Medical Billing. We have the best billing solution with an excellent track record of years. Our goal is to make “RCM” (Revenue Cycle Management) more efficient and prolific for our clients. NEO MD professionals are certified, skilled coders and billers who are up-to-date on the latest trends in Cardiology Billing. They are technically sound and well-versed in the MACRA regulations. We are capable of identifying and resolving billing system difficulties as well as increasing revenue. For services, you can contact us at ( or (929 502 3636).

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