Key Takeaways

  • From the time a patient or referring provider initiates contact to schedule an appointment, there is considerable capacity to gain efficiencies and streamline the entire process through automation.

  • Prior Authorization approvals that use AI-driven software leveraging robotic process automation and certified experts improve both bottom line revenue and significantly reduce the administrative burden.

  • Only 21% of practices are utilizing an automated prior authorization system and are instead manually submitting approval requests and performing follow-up by phone or fax.

 

Cardiology reimbursement is under the strain of a continually evolving and challenging healthcare industry, and strategies for the future should focus on automation, Artificial Intelligence (AI), and machine learning. Specialists, including cardiologists, are feeling the pinch of value-based reimbursement changes and newly enacted regulations that place a more administrative burden on the individual provider or practice.

To add another layer of complexity, patients continue to gravitate towards high deductible healthcare plans with their increased copays and deductibles as well as out-of-pocket maximums. Cardiologists are feeling the increased pressure of uncollected AR and rising collections rates that multiply when patients have not adequately planned for these increased costs. What can be done to alleviate some of this pressure and better position cardiology providers for the future?

Automated Solutions to Maximize Cardiology Reimbursement

There is significant opportunity to improve cardiology reimbursement by simply evaluating best practices in the patient access and onboarding process. From the time a patient or referring provider initiates contact to schedule an appointment, there is a considerable capacity to gain efficiencies and streamline the entire process through automation.

Reducing the administrative burden and allowing providers and staff to focus on patient care and the overall patient experience not only provides for increased revenue but has the potential to support and restore providers to their original mission — healing!

4 Ways to Automate the Patient Access Process

  1. Insurance Verification and Benefits Eligibility— In a specialty capacity, it’s more critical than ever for providers to verify insurance and benefits eligibility when patients are being referred from primary care offices. Often relying on second-hand information to schedule, it is critical to reach out directly to patients and obtain all current demographic and insurance information that can be verified through your specific automated process before scheduling occurs.
  2. Prior Authorization— According to the 2020 CAQH Index, only 21% of practices are utilizing an automated prior authorization system and are instead manually submitting approval requests and performing follow-up by phone or fax. By automating the approval and follow up functions using AI-driven software that leverages robotic process automation and certified experts for outliers, cardiology prior authorizations can be managed in real-time, and the administrative burden significantly reduced.
  3. Clinical Decision Support Mechanisms (CDSM)— Beginning in 2023, cardiology groups that perform advanced imaging will have CMS-mandated reporting requirements through the CDSM process or risk non-payment for select services for Medicare patients, including cardiac imaging. While the responsibility is on the primary or referring provider, the financial risk lies squarely with the specialist if they don’t have a CDSM Certificate on file for each procedure. A proactive solution would incorporate an interactive electronic tool from a CMS-approved vendor to manage the appropriate use criteria information and generate the necessary certificates on behalf of both the specialty and primary practices.
  4. Patient Pay Portion Collected Upfront— As part of automating your patient access workflow, generating a patient portion estimate becomes a natural partner with the insurance verification process. As patients continue to absorb more of the financial costs of their healthcare, upfront collections become increasingly important to head off a growing A/R and collection problem. Today, patients are more willing to pay before they are seen if they are given an understandable explanation of their portion.

While there are many factors at play in the changing payment structures for healthcare, one thing is for certain. By automating front-end patient access functions with AI-driven software that fully integrates with your existing EHR/EMR system, your practice will improve reimbursement and reduce administrative costs all flowing to increasing your bottom line. With better financial results, your practice will be poised for the next changes that are sure to come.

Request a demo to discover ways to automate and maximize your cardiology reimbursement.