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Handling Denials Arising Out Of Inefficient Cardiology Billing and Coding

Cardiology is one of the busiest departments in any healthcare organization. Did you know that there are 245,065 cardiology practices registered in the United States as of 2022? As the number of people with cardiac problems increases, the number of competing cardiology practices is also going higher. Medical billing and coding companies need unique expertise in handling cardiology practices because of their specific challenges.

Most cardiology practices do a great job treating patients but don’t seem to churn in the expected revenues. This could be because of problems in backend RCM processes.

Billing and coding play a significant role in determining how quickly and fairly cardiology practices are compensated for their services offered. Unless this is done right, the practice could struggle to grow financially month on month. Many cardiology practices hire third-party medical billing and coding companies to handle their backend processes because they don’t have the following.

a.Time to handle claims, appeals, denials, and rejections
b.Expertise to handle billing and coding
c.Technological and/or human skills to improve billing

The cardiology industry is growing by the day, and new diagnoses and treatments keep popping up, helping improve patients’ quality of life. This means that the billers and coders need to stay updated too. Cardiology payer guidelines keep changing, and even the smallest of negligence can lead to expensive denials. Only the most adept medical billing and coding companies can handle the pressure of billing and coding cardiology practices.

This blog will take you through strategies to help handle and avoid denials arising out of inefficient medical billing and coding in cardiology practices.

1.Stay away from reporting symptoms instead of diagnoses

One of the common mistakes that coders can make while billing cardiology claims is focusing too much on symptoms rather than the diagnosis. This is especially true when there is a confirmed diagnosis, but the physician has also mentioned multiple related symptoms.
For instance, if a person was treated for angina pectoris (I20.0 – Angina pectoris, unspecified), medical billing and coding companies should use the code for this, not for symptoms like chest pain or elevated blood pressure. Doing this can lead to confusion, and the payer may end up holding back reimbursements, asking for clarity, or worse, deny payments.

2.Focus on specific and specialized coding

Many cardiology practices take the help of third-party medical billing and coding companies because cardiology coding needs to be specialized and precise. Since cardiology involves multiple treatments simultaneously, the coders may need to use combination codes (Eg I25. 110, Atherosclerotic heart disease of native coronary artery with unstable angina pectoris.) If combination codes are not used, the payer may not reimburse the entire amount claimed or deny paying the service provider stating problems like non-verification.

The coders working for Quintessence have exceptional experience handling specialized codes and modifiers and have a natural flair for logically understanding documentation and creating the correct codes. As a result, our claim requests pass through fuss-free. Also, our ML-based coding tool, Codessence, helps take out guessing from coding and brings in accuracy and speed.

3.Focus on documentation clarity

Denials often result from incomplete documentation, which is why medical billing and coding companies need to ensure the documentation process that happens prior to coding is accurate. Coders depend on physicians and nurses for initial documentation, and codes are created based on the information in the document. When there are documentation gaps, the codes will look incomplete too. This can result in two scenarios.
a.The total billable reimbursements decrease because the codes do not reflect all the services rendered.
b.The diagnoses, treatments, and documentation don’t match, so the payer denies approving the claim.
When the initial documentation has problems, this will affect the complete RCM processes. Talk to your team about improving documentation clarity, and make sure your billing team gets back to you when they suspect gaps in the information provided instead of processing incomplete claims.

4.Stay aware of changing guidelines

If you have an in-house medical billing and coding team, you need to invest resources in periodically upgrading their knowledge. This is because payers change guidelines often, so the way claims are submitted needs to change too. A claim that was successfully reimbursed a few months back could be denied stating changed guidelines.

If you are working with third-party medical billing and coding companies, make sure they invest time and money in training their employees. Quintessence has award-winning talent-building programs that are a major reason why we remain successful. Our employees regularly go through traditional training, on-the-job learning, mentoring, and audit checks. They are encouraged to take courses and hone their skills. Our employees are also part of mandatory HIPAA and client-specific training sessions.

5.Open up communication channels

In any cardiology practice, communication channels must be open, proactive, and transparent for the RCM steps to work correctly. Physicians, nurses, billers, and coders need to be able to communicate when needed, so claims are created accurately. Medical billing and coding companies may be sitting at a remote location from their client in many cases. So how does open communication work here?

Technology is the answer.

Take Quintessence, for instance. All our clients have access to a tool we maintain called Doctor’s Portal. This tool will help create tickets in case billers and coders have queries, and the ticket will be forwarded to the physician in charge of the case. The physician will be intimated to respond, and the management will be able to know where a query is stuck in case a claim is delayed due to a lack of information. This helps create ownership, and billers and coders don’t have to wait for days to get a piece of information.


As a cardiology practice, your main concern is the quality of treatment you offer patients. That’s why you shouldn’t be burdened with complex backend processes. Billing and coding, however cumbersome they sound, directly affect your revenues and hence your sustainability and need to be done right. Letting medical billing and coding companies like Quintessence take over these tasks would leave you to do what you do your best – helping people feel better.

Get in touch with experts from Quintessence to learn how to improve your billing processes, reduce denial rates, and improve reimbursement rates without making extreme changes to your existing systems and processes.

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