Every specialty has its own unique set of billing challenges and cardiology is no different. In this post, we’ll outline the top 3 along with solutions to avoid these pitfalls.
1. Authorizations, precerts and referrals
Over-stretched office and billing staff often overlook or rush through checking for authorizations, precerts and referrals. This can prove to be a costly mistake for a practice. By doing the necessary leg work on the front end of the revenue cycle your group can prevent denials on the back end.
- Be sure to gather and verify all insurance information from the patient during scheduling.
- Registration and billing staff must ensure that all authorizations, precerts and referrals are done prior to the patient’s appointment or procedure
- Review payor guidelines for tests and procedures that require an authorization or precert. Most payor websites provide a list of codes that require an authorization.
- Verify if the payor requires referrals to include diagnostic testing or a specific level of referral for testing or procedures
2. Missing Modifiers
Failure to add the proper modifiers is a common mistake. Providers struggle to keep up with the ever-changing coding guidelines. Missing a modifier can result in a denial or delay in reimbursement and creates additional work to clean up the claim.
- Be sure to have an experienced coder or biller review charges to ensure the proper modifiers have been added.
- Engage in a third party to perform regular coding audits to check for proper modifier use, under-coding or over-coding.
3. Coverage Guidelines
Like the first challenge, many providers fail to check coverage guidelines prior to procedures and testing. In addition to the impact on reimbursement, it also impacts patient satisfaction. It is the practice’s responsibility to understand a patient’s coverage. Your team should be prepared to counsel patients prior to procedures and testing to ensure there are no surprises.
- Review payor policies for under what circumstances a procedure or test would be covered.
- Verify what associated diagnosis codes will support that medical necessity
- Remember a patient’s coverage can change. Be sure to review the guidelines for the most recent payor and plan to avoid surprises during billing.
All 3 challenges can have a great impact on a cardiology group’s revenue cycle and most importantly cash flow. Each can be easily avoided with clear processes in place throughout each stage of the revenue cycle.
For more information on Coronis Health and how we can help improve your practice’s revenue cycle, contact Kate Tingley, Director of Marketing at firstname.lastname@example.org.