With increasing healthcare costs and patient responsibilities, healthcare providers are now facing major pressure to keep up with the latest trends for their medical billing and coding service needs. Providers also lose more than 20% of actualized revenue due to poor Revenue cycle management strategies and lack of billing expertise. When it comes to Cardiology, the stakes are higher due to the complex nature of the specialty.
Every specialty needs its own prioritized solutions to increase revenue for the practice. Here are the top 6 ways to improve your diagnosis and thereby your medical billing and coding for cardiology.
- Documentation – Incomplete documentation is one major cause of reduced collections in cardiology. Coding for cardiology is as such tricky and any insufficient documentation results in inaccurate coding and this in turn may leave you exposed to unwanted audits. Documentation should be complete and legible. Prioritizing and giving attention to some simple nuances like documenting factual input, updating information as and when an encounter occurs and confirming all the information by signing, can save thousands in revenue for the practice.
- Understanding Comorbidities – Comorbid conditions denote the presence of one or more pre-existing conditions along with the primary diagnosis that can significantly affect patient management and treatment options. It is imperative to clearly document the comorbid conditions in his medical record, and it is equally important for the condition to be identified and reported. This helps the payer understand other conditions of the patient and can help in the better analysis of the cost that can be incurred for the patient. Providers are also reimbursed at a higher rate when reported with the presence of comorbidities. E.g Treatment options and plan of care and patient management provided to a patient with no underlying chronic conditions like Diabetes would be less complex than that provided to a patient with chronic diabetes.
- Usage of Combo codes – One of the most significant changes brought by ICD 10 CM in cardiology is the expansion of code definitions, the introduction of terminology differences, and increased code specificity. One such complex category is the combination code. These are codes that are used to denote two diagnoses or a diagnosis that has an associated secondary process. It can also denote a diagnosis with a specific complication. Eg. I25.110 – atherosclerotic heart disease of native coronary artery with unstable angina pectoris, I13.0 for Hypertensive heart and chronic kidney disease with heart failure. It is very important that when there is a combination code available, we cannot use multiple coding. If the combo code does not clearly state the specificity, secondary code can be used.
- Identifying Symptom from confirmed diagnosis – When a confirmed diagnosis is documented, the symptoms related to the confirmed diagnosis should not be coded. E.g a patient presents with chest pain and the diagnosis of myocardial infarction is documented. I21.9 (acute myocardial infarction) should be the only ICD code billed and not R07.9 (chest pain) should not be billed even as a secondary code.
- Obtaining Prior Authorization – It is said that providers spend an average of 20 hours a week determining prior authorization. Many providers lose revenue due to missing or invalid authorization. Several cardiac procedures require prior auth from payers including, Catheter placements, Pacemaker installation, stress echocardiogram, and implantation of hemodynamic monitors. Obtaining prior authorization can help increase your revenue by at least 15-20%
- Artificial Intelligence, Machine Learning, and Robotic Process Automation – Investing in the right technology for your practice can be the best way to improve your collections in long run. Quintessence has over a decade of expertise in Medical billing and coding services for cardiology, and we have developed unique solutions in Medical coding, billing, denial management, and payment posting. From a computer-assisted coding platform to workflow optimizing solutions and BOT’s that automate processes like eligibility verification, Charge entry, and claim submission, Quintessence has your entire medical billing and coding services need covered.