Cardiology Medical Billing Guide to Lower Denial Rates

Highly specific procedures, detailed documentation needs, and high claim denial rates—these are just a few of the nuances that inform cardiology medical billing.

In this specialty, accurate and precise billing is a must. Done well, billing processes can contribute to a practice’s revenue stream; done poorly, practice revenue can take a hit, potentially impacting patient care.

What do today’s billing specialists need to know to master cardiology medical billing, reduce their odds of claim denial, and maintain practice-wide revenue streams? Explore the guide below for a crash course in cardiology billing.

The Complexities of Cardiology Medical Billing🔗

Cardiology as a specialty is medically complex; the billing process can be, too. Cardiology billing codes are highly specific, with some testing categories claiming twenty-plus CPT/ICD codes.

Take the electrocardiogram (ECG): a common exam performed by cardiologists to assess patient heart rate and rhythm. This exam could be billed via one (or more) of many highly specific codes. Individual ECG codes specify:

• The number of leads used during the test
• Whether or not the provider analyzes the results
• The duration of the test
• The extent of data recording and storage

Cardiology medical billing specialists should start by familiarizing themselves with the most commonly used procedure codes in the specialty, as outlined by the Centers for Medicare & Medicaid Services (CMS):

• 93015 – Cardiovascular Stress Testing
• 93325 – Doppler Echocardiography Color Flow Velocity Mapping
• J0153 – Injection, Adenosine, 1mg
• 93451 – Right Heart Catheterization
• 93452 – Left Heart Catheterization with Ventriculography
• 93505 – Endomyocardial biopsy
• 75710 – Artery X-Rays Arm/Leg

Since cardiology billing is so complex, cardiology documentation can be, too. Accurate billing requires accurate record-keeping; scribes and clinical staff must be well-trained to document even the most specific elements of cardiology procedures.

3 Common Cardiology Billing Challenges (And How to Solve Them)🔗

The complexity of care is only one hurdle that cardiology medical billing experts must overcome. In addition to regulatory compliance challenges (related to HIPAA, ICD-10, and Medicare), the following roadblocks are some of the most common for cardiology practices.

#1 High Claim Denial Rates🔗

Many providers encounter high claim denial rates for cardiology procedures and care. However, there are a few ways to avoid some of these denials:

• Thorough documentation – Documents should explicitly note the procedures and interventions provided to each patient; billing specialists can use these to submit accurate codes and provide follow-up documentation if claims are denied.
  
• Accurate coding – In the same vein, triple-checking code submissions is a must. Even minor mistakes or transposed digits can lead to denials, extending the billing timeline.
  
• Eligibility verification – Before submitting a claim to an insurer, billing specialists should check patients’ policies to verify coverage. If a procedure or intervention isn’t covered, billing can skip the claim process altogether and bill the patient directly.
  

#2 Prior Authorization Hurdles🔗

Another common reason for cardiology claims denials is missing prior authorizations. Without prior authorization from their insurer, patients may not receive coverage for a planned procedure.

To prevent this, keep an eye out for cardiology procedures that commonly require prior authorization, like:

• Radiology and imaging
• Electrophysiology implants
• Diagnostic catheterization
• Echocardiogram
• Stress echocardiogram
• Elective or planned surgeries or hospital stays

One way to catch these procedures and ensure prior authorization is to implement workflow checks—including redundancy and oversight to review authorizations. This is just one way to promote medical billing best practices.

#3 Keeping Up with Evolving Coding Guidelines🔗

Like other specialties, codes are frequently updated in cardiology—yet another contributor to claims denials.

When it comes to medical billing as a whole, continuing education is a must for every practice. As codes, best practices, and regulations evolve, billing professionals need to stay up-to-date to ensure accurate, timely billing.

Practices can ensure that staff stay up to date by:

• Purchasing updated copies of the ICD/CPT codes each year
• Enrolling staff in professional development or refresher courses
• Signing up for digital updates from insurers and regulatory bodies
  

Best Practices for Efficient Cardiology Medical Billing🔗

Aside from the approaches above, what can medical billing specialists do to improve claims approval odds in cardiology? Let’s explore three approaches designed to support practice revenue cycles.

Front-End Efficiency: Verification and Clean Claims🔗

One way to increase your practice’s clean claims is to lean into front-end procedure changes. For cardiology offices, that might look like:

• Verifying patient insurance eligibility and benefits before rendering services
• Confirming and collecting prior authorizations as far in advance as possible
• Checking that the documentation supports the procedures billed
• Implementing additional checks and oversight to improve claim accuracy

While all of these tactics can help reduce delays in payment and claims denials in general, these approaches are especially important for complex procedures or interventions requiring multiple codes. Improving the pre-procedure review process can streamline the entire billing process.

Ongoing Optimization: Staff Training + Smart Tech🔗

While we touched on continuing education for billing staff, it’s worth another mention: Keeping coders and billing specialists trained on the latest CPT/ICD code updates relevant to your specialty is worth the investment.

By investing in high-quality, ongoing training, practices can improve their revenue cycle long-term. Put simply, education is an asset with undeniable returns.

In addition, training staff on emerging billing technologies can help them detect and prevent errors. Electronic health records (EHR) are becoming the norm; so are EHR-integrated billing platforms. These platforms feature automation tools to flag incomplete claims and identify coding mistakes.

Perhaps most importantly, these technologies allow billing specialists to automate the most rote tasks: eligibility checks and claims scrubbing are just two examples. By freeing up time with automation, practices can devote more resources to complex billing cases.

Monitor Key Metrics to Drive Revenue Cycle Performance🔗

An effective revenue cycle management (RCM) approach produces measurable results. However, to assess how well your RCM strategy actually works, you need data.

Tracking key performance indicators (KPIs) can help you make informed improvements in workflow, training, system usage, and more. Practices can start by tracking straightforward metrics like:

• Claim denial rate
• Days in accounts receivable (A/R)
• Clean claim rate
• Average claim response time
• Rates of accurate prior authorization collection

With this data in hand, billing specialists, managers, and clinicians can track their progress, identify ongoing areas of improvement, and assess the effectiveness of newly implemented approaches.

The Role of Outsourcing🔗

Practices experiencing high denial rates, difficulty tracking KPIs, and revenue cycle challenges can contract with professionals to ease some of the most nuanced challenges in cardiology billing.

Third-party billing and RCM providers can help practices reduce errors, improve ROI (for software, training, staffing, and more), and boost overall cash flow.

Your third-party partner of choice should offer solutions that are:

• Scalable – Their services should grow with your practice and administrative needs over time.
  
• Patient-focused – Service providers should be motivated to improve patient outcomes, not just increase revenue.
  
• Forward-thinking – Third-party billing providers should be up-to-date on the latest billing technologies, best practices, and regulatory requirements.

Medusind meets all of these criteria and more.

Future Trends in Cardiology Medical Billing🔗

Cardiology medical billing is complicated, and that’s unlikely to change anytime soon. However, today’s practices have more tools than ever before to manage these nuances and develop a healthy revenue cycle.

Practices seeking third-party, expert billing and RCM support can turn to Medusind: a team of billing professionals committed to unlocking the full potential of practice revenue cycles. And we do more than ease administrative burdens and speed up A/R—we help practices implement changes that improve patient care and outcomes.

Explore our services and discover a new approach to cardiology medical billing.