With its many levels and intricacies, coding can impact revenue reimbursement and, ultimately, the bottom-line. Coding in its various forms has been around for over fifty years. It has grown to be synonymous with justifying a provider’s care decisions and the patient’s level of service for billing purposes. Regardless of the care setting, ICD-10-CM (outpatient and practice-related) and -PCS (inpatient), CPT, and HCPCS coding are extremely important when maximizing insurance reimbursement, and minimizing claim denials and outright rejections.
If your cardiology business operations model relies on an in-house coding team, you may be experiencing avoidable delays in payment and timeliness in collections due to denials. To improve your coding program’s results, consider the benefits of engaging a third-party medical coding partner.
Coding Challenges for Today’s Cardiology Group
To avoid long-term consequences, it is critical to stay abreast of the challenges and complexities related to healthcare coding, and this requires an overwhelming effort to stay current in addition to the day-to-day coding workflow. To add additional stress, oversight by governmental and commercial insurance payers track code usage by the provider, If a problem is identified, there can be severe legal and financial ramifications. Consider some of these issues:
- Does the Code Match the Actual Service — Were the right codes selected for the services provided. While this may seem implausible, in 2017, the average coding accuracy rate for inpatient services was only 61%.
- Appropriate Modifiers — Are appropriate modifiers for CPT and HCPCS codes used whenever necessary, i.e., new telehealth guidelines require modifier -95 to denote a remote location.
Documentation — Every patient encounter should be documented to the fullest to assist in coding, and prior authorization requests, insurance requests for information, denials management, and possible audits.
- Unbundled Charges — Every procedure or test must only be charged separately when not part of a designated diagnosis bundle.
- Level of Specificity — Care must be used to code to the highest level of specificity (maximum number of digits allowed) and not under-coded by complexity.
- Correct Order — Codes must be entered in the order used, with the first code being the specific reason the care was delivered.
- Upcoding or Downcoding — coding should be for the exact level of service performed; purposely up or down coding can have serious consequences.
Many Cardiology Leaders Are Vetting 3rd Party Coding Partners
Moving at an accelerated pace, cardiology practices see appointed patient care mixed in with emergencies and unforeseen issues. Employees tasked with the critical functions that make up the business operations rarely have time to complete their daily activities while chasing down provider documentation and charge slips.
This makes staying current on relevant, changing coding guidelines a difficult challenge. And beyond the daily workflow, there is little if any ability to perform audits and quality control. By engaging a 3rd party coding partner, those functions become part of their business flow. Also, you can expect:
- Increased reimbursement using a thorough knowledge of primary and specialty coding, as well as inpatient experience,
- A vast, comprehensive understanding of the governmental and commercial insurance market,
- Data analytics and process improvements available 24/7, so that you know where your organization stands financially,
- Ongoing support and training for providers and staff, and
- Robust compliance and quality improvement program.
With improved coding execution, your cardiology group would experience an increase in reimbursement that directly impacts the bottom line. Considering such a partnership brings a high functioning and well-trained coding program capable of capturing the maximum reimbursement for its services..
Contact us to find out more about improving your overall cardiology coding program.