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A Complete Guide To Cardiology Medical Billing

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If you’re looking for cardiology medical billing, you might feel overloaded by the number of companies and services claiming to offer the best solutions. Without prior training or first-hand experience, many practices can struggle to choose a company or team that can handle their most basic needs and the complex challenges specific to their specialty.

This brief article explains what cardiology is, the basics and importance of cardiology medical billing, some of the most common billing and coding mistakes in this field, and key services that make superior medical billing companies stand out from the rest.

What Is Cardiology?

Cardiology is a specialty medical practice that deals with the function, structure, prevention, and treatment of heart and vascular system disorders. Cardiologists most commonly treat chest pain, high blood pressure, and serious vascular issues such as coronary artery disease, heart rhythm abnormalities, congenital heart defects, and heart failure. Cardiologists usually provide physical examinations, tests like echocardiograms, CT scans, electrocardiograms, medication, and guidelines on exercising and eating healthier to improve your vascular health. Some cardiologists will specialize in more specific fields, such as sports cardiology, electrophysiology, peripheral interventional cardiology, and critical care.

Why Is Cardiology Medical Billing Important

Cardiovascular disease (CVD) remains the leading cause of death in the U.S., accounting for almost one million deaths in 2020. Without this essential healthcare service, more people could suffer from coronary heart disease, strokes, high blood pressure, heart disease, and artery disease.

Cardiology medical billing is even more important when you total CVD’s direct and indirect costs on the US economy, totaling $407.3 billion between 2018 and 2019. Without proper medical billing, cardiologists can lose track of their expenses, claims, and the health of their practices.

If cardiology practices fail, the clients and patients they serve lose access to vital healthcare services. Cardiologists and their staff need to thoroughly understand medical billing, including payor and state-specific guidelines and coding practices. The American Medical Association (AMA) updates these guidelines and codes yearly to reflect medical practice and technology changes, and practices can’t afford to fall behind or fail to educate themselves. Medical billing directly affects reimbursement rates, reputation with payors and government programs, and cardiologist’s ability to provide quality patient care.

Basics of Cardiology Medical Billing

Cardiology medical billing mainly uses the Current Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision (ICD-10) coding systems to document and bill for services. CPT codes represent the specific services provided to patients, and ICD-10 codes represent diagnoses and reasons for the services rendered. The most common codes used in cardiology medical billing include:

  • 93000: This code represents an electrocardiogram (ECG) and a report explaining the results.
  • 93306: This code stands for an echocardiography, a heart test using sound waves to make real-time pictures of the heart. 
  • 93510:┬áThis code represents a cardiovascular stress test using exercise equipment and an electrocardiogram.

Cardiology medical billing also includes:

  • Verifying patient information and insurance eligibility: Cardiologists must verify their patient’s insurance policy status, coverage, and associated co-pays or deductibles. This helps avoid denied claims due to providing uncovered services or specific services without prior authorization.
  • Submitting claims: Once cardiologists provide healthcare services to patients, they need to submit their claims to the payor to receive reimbursement. It’s important to be familiar with each payor’s process.
  • Appealing and reprocessing denied claims: Cardiologist practices need to appeal or correct denied claims to receive payment for their services. Some studies revealed that 65% of denied claims are unresolved, even though 75% are resolvable.

Read more: Credentialing In Medical Billing: Importance, Advantages, & More

Common Cardiology Medical Billing & Coding Mistakes

Like other specialties, cardiology medical billing has its own complex issues that can lead to denials and revenue loss if left uncorrected. The most commonly made mistakes in cardiology medical billing and coding include:

  • Ignoring coverage guidelines before providing procedures and tests: Cardiology usually involves various tests and scans to check for diseases and issues within the vascular system. However, many insurances require prior authorization and proof of medical necessity before providing investigational services. If you don’t check your patient’s insurance eligibility before treatment, payors can deny your claim, and patients will become frustrated when they receive a surprise bill in the mail.
  • Skipping comorbidity coding: Cardiology patients are no strangers to receiving multiple diagnoses, such as diabetes, high blood pressure, and chronic obstructive pulmonary disease. It’s vital to document these comorbidities and use the proper combination codes. For example, some patient’s heart failure is caused by hypertension and requires two treatment methods. Skipping these combination codes can result in denied claims or a loss of revenue from providing an additional service.
  • Skipping modifiers: Modifiers are two-digit codes that alter the original five-digit CPT-coded service. For instance, if, during a patient visit, the clinician determines that a stress test is needed afterward, you can apply modifier 25. This modifier is designed for a “significant and separate evaluation and management (E/M) on the same day as another procedure or service.” Failure to use modifiers correctly could result in lost revenue for your practice, as the payer may combine the visit with the stress test procedure.
  • Vague coding: Every cardiovascular disease or condition has various diagnosis codes describing the service depth. Payors can deny your claims if your coding isn’t specific enough. A code for systolic congestive heart failure (150.2) is very close to the code for combined systolic and diastolic congestive heart failure (150.4). Another important rule is ensuring you’re coding for additional symptoms only if unrelated to the diagnosis.

What You Want From Cardiology Billing Services

It can take time to build your own in-house medical billing team or choose from the hundreds of medical billing companies in the U.S. We’ve compiled these seven additional services that some medical companies don’t offer, even though they can greatly improve your medical billing process.

  1. Pre-payment review (PPR) and provider network integrity (PNI): Reliable cardiology medical billing companies should guide you through routine PPR and PNI audits and maintain communication before, during, and after the process. This can help your team prepare and have the necessary tools and skills for the next one.
  2. Advocacy: The best medical billing companies should be able to represent your practice and its values when addressing issues with payors. You also want a medical billing company that looks after your industry as a whole, helping push and advocate laws and policies that improve cardiology services across the board.
  3. Data analysis and growth strategy: Look for a company that provides and establishes benchmarks for how cardiology is doing nationwide, including profits, patient care quality, and practices other cardiologists follow. They should also help you grow using specific insights into your location to help you grow strategically.
  4. Education: Most of your staff likely went to school for their specific medical skills, and not everyone picks up coding or billing skills simultaneously. Find a medical billing company that routinely meets and supports your staff’s needs.
  5. Denial management: Some cardiology medical billing companies don’t follow up with denied or underpaid claims from payors. Look for a company with legal expertise that can escalate issues like this on your behalf.
  6. Negotiations: Comprehensive medical billing services should include negotiating and renegotiating care contracts for your cardiology practice to expand your number of in-network patients.
  7. Customer service: Look for a billing service that prioritizes customer service and is adept at facilitating the integration of telehealth solutions to enhance patient access and care.

Read about: 2023 Case Study: Pain Management Clinic

Contact Hansei Solutions

Contact Hansei Solutions if you want a cardiology medical billing company that goes above and beyond standard billing services. Our revenue cycle and billing team truly want to see your practice grow and make company-wide improvements that help you and your staff focus on patients first. Hansei is here to address your practice’s pain points and grow your company to its fullest potential. Contact us today and schedule a free demonstration of our cardiology billing services.

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