Practice Managemet Survey 2015



Cardiology Billing and Coding In and Out

There was a time when cardiologists or billers and coders handling cardiology billing and coding were content in the belief that they knew cardiology billing and coding in and out. This contentment came from the fact that cardiology traditionally had fewer codes, compliance standards and regulations. But now cardiology billing and coding regulations have brought in codes that are very detailed in nature and represent all aspects of a cardiology treatment, from diagnosis to surgery.

On a more specific note, with the coming of ICD 10, cardiologists have to deal with various billing and coding requirements such as acceptability of codes assigned, their corresponding modifiers, medical need of performing and coding a procedure, component coding, etc. The credit of this change goes mainly to the fact that – ICD 10 includes approximately 40 codes more than ICD 9; is very specific in nature and represents greater number of areas and subareas of cardiology treatment.

The range of billing and coding needs mentioned above has made cardiology billing and coding an extremely specialized affair, one that needs:

  • Intricate knowledge of cardiology as an area of treatment
  • Knowledge of codes
  • Sound documentation to substantiate the medical need of procedures

But as much as code knowledge and documentation are important, the first requirement stated above – knowledge of cardiology as an area of treatment – has assumed much more importance since the introduction of a new CMS regulatory change brought last year.

CMS has divided a cardiology treatment into two parts – therapeutic and diagnostic – and has removed parts of both from the ambit of reimbursement variously. For example, it discourages administration of more than one cardiology procedure in one day, so that if more than one cardiology procedure is carried out in a day, then the technical component of the lesser expensive cardiology procedure will be reduced by 25 percent. In other words, only 75 percent of the technical part of the cardiology procedure will be reimbursed.

Additionally, CMS has also removed lot of cardiology billing services altogether from the ambit of reimbursement.

MBC’s Revenue Management Consulting services can help you with the above-mentioned activities by guiding you in assessing your in-house revenue management cycle and ensuring that there is sound coordination between various components of healthcare and facilitating smooth flow of medical data among various phases and care components of cardiology. We also identify gaps in your process and address them by providing guidance in replacing, if necessary, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training. We have helped both small and big cardiology practices overcome their ICD 10 challenges and keep their revenues buoyant. the largest consortium of billers and coders in the US, has also been helping several small to medium size cardiology service providers with its Outsourcing services handling the entire range of activities involved in billing and coding starting from preparation of claims through submission to post-submission follow-ups. Our cardiology billing and coding services are flexible and you can pick and choose such parts of our solutions as exactly suit your needs and save money.

Prepare Your Practice for ICD-10 coding challenges and documentation

  ICD-10 will be reshaping the coding and documentation procedure to a great extent and failing to prepare for the same will result in lost revenue. Poor quality documentation and coding will not just affect providers but it will also have a negative impact on payers and patients. One of the best ways to start preparing your practice for ICD-10 is to train your coders and improve clinical documentation because the new coding system will require higher level of specificity.

With accurate ICD-10 documentation and coding, you will be able to enhance patient care as detailed documentation lends collaborative support and insight to other practitioners. It will also help in improving quality reporting, patient safety and clinical decision support.

Once ICD-10 is implemented, documentation should assure transparency and accountability and capture the right level of severity and risk. Error-free coding will result in timely billing and this will help your practice get paid on time, reducing claim denials and delay in payments.

How to prepare for ICD-10 coding and documentation?

Coders can code only on the basis of what the physician has documented. Even if coders are well-trained for handling the new coding system, they can do nothing to get you paid if there is lack of detailed documentation from the clinician’s side.

  • Clinicians will have to devote more time to ensure precision in documentation. For this, practices will have to assess the current documentation process and train the clinicians for the required changes
  • Necessary technology changes will have to be brought in to help physicians comply with enhanced documentation requirements
  • Coders will have to make sure that ICD-10 coding is consistent with the documentation. They will require training in new code classification
  • A business manager will be required to ensure that every billing at your practice is accurately coded and supported by documented information
  • A budget will have to be created in order to prepare for transition to ICD-10 which will range anywhere between $83,000 to $2.7 million per practice
  • HIPAA-5010 requirements will have to be fulfilled for ICD-10 claim processing as the new codes will not be supported by HIPAA-4010

Focus is rising on provision of quality care but due to rise in number of patients, physicians are not getting ample time to concentrate on documentation and other administrative tasks. Lack of time and money is posing problems in hiring and training coders, retaining existing staff, buying expensive technology and prepping for ICD-10 due to which many practices are seeking help from billing companies. is the largest consortium of billers and coders that has been helping practices in successful transition to ICD-10. Our coders have the required expertise to handle the demands of ICD-10 and HIPAA-5010 compliance. While our team reduces your headache of hiring, training, implementing health IT, claim filing, denial management, you can concentrate on improving documentation. The well-trained team at MBC will manage your revenue cycle, maximize your profits while you offer quality care.

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