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~ Compliant Coding with minimization of medical necessity denials.
~ Billing with accurate fees to the insurances.
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~ Daily reporting of documentation deficiency reports.
~ Guaranteed revenue increase by 5-15% of your collections.
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Cardiology is a branch of medicine pertaining to heart and parts of the circulatory system. This branch includes diagnosis and treatment of congenital heart defects, heart failure, coronary artery disease, diseases related to valves and electrophysiology. There has been a great progress in cardiology during the 20th century which was possible by improved diagnostic tools such as electrocardiography, echocardiography, cardiac catheterization, angiography and much more.
Cardiologists have a lot of impact, as heart related problems are the leading cause of death in the world. As a rapidly evolving branch of medicine which has complex treatment protocols involved, cardiology coding and billing is a challenge to many of the practioners. As there are many changes/updates in coding and billing, most of the cardiologists are facing problems with underpayments for the services rendered.
Rely on Us can help you with quality billing services and expert advice, maximizing your revenue in-flow much higher than what is expected and in compliance with the service provided.
Inaccurate / Missed documentation leading to underpayment: Cardiologists usually perform multiple procedures in one session and it is found that most of the records do not have accurate documentation in place representing all the procedures performed. Documentation gaps will lead to under-coding, incorrect selection of code or missing a code. This ultimately leads to reduced payments and trigger point for an audit. Therefore, it is very crucial for a cardiologist to provide an accurate report and be up to date on patient’s current condition to prevent from negative audit findings and under-payments.
Bundled procedures: Bundling of CPT® occur when a unique service is included as a part of more extensive procedure billed at the same time. We have many combination codes in place where a single code represents 5-6 procedures performed in one session.
An example of a bundled service/combination code
CPT® 93453 represents both right and left heart catheterizations, injections for left ventriculography with imaging supervision and interpretation.
The coder should be cognizant of bundled and unbundled procedures ensuring there is no hindrance in claims processing.
Frequency limitations: There are many codes which are time based mainly under electrophysiology section of cardiology. LCD policies provide more information on the frequency limitations. Having an eye on LCD guidelines helps in staying away from denials.
Modifier usage: Modifiers are required to provide information of circumstances that may affect payment. Usage of appropriate modifiers helps minimize denials and maximize reimbursements. Below is an example –
Modifier 22 can be appended when there is increased intensity of the service or time consumed in performing the service, technical difficult procedure, procedure involving more physical and mental effort, when patient condition is severe.
When 22 modifier is appended, the allowed amount depends on the median intra service times as per the PFS Proposed Rule Physician Time excel file, representing “Work Time”.
Regular updates or changes in CPT® codes, LCD guidelines and fee schedule: Having updated knowledge in the changes coming across day to day in cardiology practice is more critical considering extreme pay cuts and raised audit scrutiny.
Here is an example –
Moderate sedation – Moderate sedation is no more a bundled service and it can be reported separately whenever medically necessary and the code requirements are met. CPT® codes 99143-99145 and 99148-99150 have been replaced with the new set of codes 99151-99153 and 99155-99157. Time requirements have also been changed from 30 minutes to 15 minutes to report 1 unit of service.
Dynamic Leadership: Cardiology is a specialty with intricate guidelines requiring a team of robust experience and knowledge to handle the process. The success of any process depends upon the team we create and Rely on us has such a promising team who would inevitably bring a phenomenal change in your business revenue in-flow and we have proven records that set standards for our credibility.
Transition Strategy: We have live examples with our existing clients where we had come up with exclusive strategies for a smooth transition from onshore.
Consistency: With the consistent change in the guidelines, the need for an unswerving team is very much a requirement. Rely on us is capacitated with a promising team with low or no attrition ensuring we are committed and consistency in our deliverables.
Competencies: The work of a physician reduces indefinitely times when he can find a team with highest competency levels. Rely on us staunchly believes in competing with their peers in true spirit.