Optimism can sometimes be in short supply in today’s healthcare environment. Reimbursement continues to decline, bottom-line cash flow suffers, and patients struggle with increased financial responsibilities. With an aging population, the need to improve cardiology revenue will only continue to grow, and life-sustaining procedures and treatment will keep on being scrutinized by governmental and private insurance providers.
While this squeeze has created anxiety within the healthcare field, it also brings ingenuity and inventiveness into sharp focus as solutions begin to rise to the surface. Patient access and the revenue cycle management area can bring significant improvements to the cardiology bottom-line through increased reimbursement capture and streamlined administrative functions.
Improving Cardiology Reimbursement
1. Prior Authorizations Lead the Charge
If asked to name the #1 pain point for cardiology practices system-wide, prior authorizations (PAs) almost always tops the list. The idea is good in theory, but in practice leads to care being postponed (if not abandoned outright) and inflated administrative burden while trying to manage the system to the satisfaction of insurance companies.
Bringing intelligent automation into the equation has shifted the paradigm significantly. Instead of resisting the process, artificial intelligence (AI) driven software that utilizes machine learning and advanced predictive capabilities allow practices to lean into the process. With a fully automated process, PAs are prepared if required, submitted to the appropriate insurance company, and followed-up—all in real-time.
In this scenario, patients can be scheduled more efficiently, insurance claims will be denied less frequently, and administrative billing staff can be freed up to dedicate time to higher-level functions.
2. CDSM Will Soon Impact Revenue for Medicare Patients
The Clinical Decision Support Mechanism (CDSM) is currently in the working phase, but in January 2021, missing certificates of compliance will negatively impact Medicare patient reimbursement. If your cardiology practice refers, or performs advanced testing as mandated through the CMS guidelines, you will be impacted by these guidelines.
The Centers for Medicare and Medicaid Services (CMS) has a list of approved vendors that offer interactive electronic tools where providers can utilize the Appropriate Use Criteria (AUC) information to assist them in making the optimal clinical decision and then generate a certificate to be submitted with the claim to Medicare.
3. Coding and Billing Support Through A Third-Party Partner
Practices experience ebbs and flow throughout the year that creates an uneven workflow and increased administrative problems. Besides the issue of scaling resources, there’s also the challenge of supporting staff in their effort to stay abreast of the latest trends in ICD-10 coding.
By teaming with a third-party coding and billing partner, accuracy typically rises, scaling is no longer a problem, and changes and updates are handled automatically with no burden placed on the practice. With a third-party team in place, you operate on an informed basis through data analytics that gives you a snapshot of AR at any given time with no guesswork.
Each of these improvements adds time that providers can rededicate to their practices, while also adding to the bottom-line. Additionally, this impacts the patient experience and presents a more organized and streamlined operation.
Let us show you the best ways to improve your cardiology bottom line through advanced billing and payment systems.