Claim Denials for CardiologistsCardiologists occupy a significant position in treating cardiovascular diseases and patient’s prognosis in the healthcare sector. However, in addition to their care for patients, cardiologists are confronted by the complex task of dealing with billing and reimbursement procedures. 

Being a healthcare provider, do you ever find yourself in a situation where you give your best care to a patient  but receive a denied claim from insurance? You’re not alone. The research reveals that around 20% of cardiology claims face initial submission denials. But here’s the surprising part: for those, most of these denials are for undefined reasons. 

This article focuses on 6 unexpected reasons for claim denials. When you know the reasons, you can easily avoid them and  maximize your reimbursement. 

Understanding Cardiology Billing

Cardiology billing, in simple words, is the process of submitting claims to the insurance company for reimbursement of all the medical services provided to heart patients. It starts with the documentation of the patient encounters and ensures it covers all the demographic information as well as services rendered to the patients. Once documented, medical coders assign the appropriate codes to each service. This coded information is fetched by the insurance company for reimbursement. If everything adheres to the regulatory guidelines of the payer, the healthcare provider is reimbursed, or else the claim is denied.

Common CPT Codes for Cardiology Billing

Here are some common CPT codes used in cardiology billing:

  • Echocardiography:
      • Transthoracic echocardiogram (TTE): CPT code 93306
      • Transesophageal echocardiogram (TEE): CPT code 93312
      • Stress echocardiogram: CPT code 93350
  • Electrocardiography (ECG/EKG):
      • Electrocardiogram, routine ECG with at least 12 leads: CPT code 93000
      • Holter monitoring (24-hour): CPT code 93224
      • Event monitoring (30-day): CPT code 93268
  • Cardiac Catheterization:
      • Left heart catheterization, including coronary angiography: CPT code 93458
      • Right heart catheterization: CPT code 93530
      • Coronary angioplasty with stent placement: CPT code 92928
  • Pacemaker and Implantable Cardioverter-Defibrillator (ICD) Procedures:
      • Insertion of pacemaker, single chamber: CPT code 33206
      • Insertion of ICD, single chamber: CPT code 33249
      • Replacement of pacemaker pulse generator: CPT code 33227
  • Nuclear Cardiology:
      • Myocardial perfusion imaging, single study at rest or stress: CPT code 78452
      • Myocardial viability study with SPECT: CPT code 78478
  • Cardiovascular Stress Testing:
      • Exercise treadmill test: CPT code 93015
      • Pharmacological stress test: CPT code 93017
      • Stress test with imaging (e.g., nuclear or echocardiography): Various CPT codes depending on the specific imaging modality used
  • Cardiac Rehabilitation Services:
      • Cardiac rehabilitation, supervised, per session: CPT code 93797
      • Medical nutrition therapy, initial assessment and intervention: CPT code 97802
  • Peripheral Vascular Procedures:
    • Peripheral angiography, unilateral: CPT code 75710
    • Lower extremity arterial revascularization, with open or percutaneous intervention: CPT code 37221

6 Unexpected Cardiology Billing Denials

Following  are top 6 unexpected billing denials that negatively impacts the revenue cycle of the cardiology practice:

6 Unexpected Cardiology Billing Denials

Missing or Inaccurate Information

Cardiology providers usually enter complete and correct patient data in the claim forms. However, there are instances when a patient’s information is either missing or incorrect, such as incorrect demographic data or unrecorded insurance identification numbers. This  results in a claim denial for the cardiologist.

Lack of Preauthorization

Many insurance plans call for authorization for certain cardiology procedures and tests. Failure to obtain preauthorization can result in claim denials or even payment delays. To prevent this, make sure your practice establishes a system that verifies each patient’s insurance requirements prior to scheduling procedures. Train your staff members to identify steps requiring preauthorization and begin the authorization process as soon as possible.

Illegible Claims

The legibility of claims, which may be either handwritten or electronically submitted, becomes an issue if they are not processed correctly. Make sure that the claims are visible and have precise information. EHR (Electronic Health Record) systems or practice management software should be utilized to automate the claim submission process and minimize the chance of illegible claims.

Duplicate Claims

Duplicate claims for the same cardiology service are one of the most frequently encountered billing mistakes and are the reason for different denials. Cardiology medical practice should integrate measures of avoiding duplicate submissions and rather each claim in putting forward.

Medical Necessity

Inadequate documentation of medical necessity for cardiac services often causes claim denials or rejections. Cardiology practices must take care to justify every procedure and test done, as this will help the facility gain reimbursement.

Non-Covered Services

Some cardiology procedures, in the instance where a medical practitioner is required to conduct them, are sometimes not covered by insurance companies. This may result in the claim being dismissed. Whether the patient has coverage or not, it is crucial to advance these practices and provide guidance on potential cost-sharing for non-covered services.

Strategies to Overcome Cardiology Billing Claim Denials

To overcome the hurdles of claim denials in cardiology billing, healthcare providers can implement the following strategies:

Denials Management Process

Put in place a structured denials management system that accelerates the processing of claim denials. Assign responsibility for tracking and investigating denials, root cause identification, and actions to prevent future denials.

Preauthorization Verification

Establish a well-organized scheme to check authorization for cardiology tests and procedures before making appointments. Ensure that employees receive training to identify procedures requiring preauthorization and initiate the authorization process promptly to prevent denials.

Clear and Legislative Documentation

Highlight the necessity for accurate and readable recording of patient interactions. Encourage payers to utilize electronic health records (EHR) systems or legible handwriting to ensure accurate entry and interpretation of all required information.

Comprehensive Coding Training

Provide continuous training for coding staff so that they can code the cardiology services precisely and completely. Keep staff informed about coding guidelines and changes that may arise to ensure compliance and prevent coding mistakes that may result in denials.

Claims Scrubbing Software

Invest in claims scrubbing software, which can identify coding errors, duplicate claims, and other issues prior to the submission of claims. Taking a proactive approach can help prevent denials and reduce the billing time.

Documentation of Medical Necessity

 Educate health care providers on the significance of documenting the medical necessity of cardiology procedures and tests in patients’s records. Foster a culture of detailed note-taking of clinical indications, findings, and treatment plans in order to provide adequate support for the services provided.

Patient Information Verification

Establish protocols to verify patient information, including insurance details and demographic data, at every occurrence during the patient visit. Triple-checking patient data prior to the submission of the requests can avoid the denial of claims because of the uncorrected or incomplete patient data.

By implementing these effective strategies, cardiologists can overcome the issue of claim denials in cardiology billing. 

Outsource your Cardiologist billing services to Medheave

Outsourcing cardiology billing services to the MedHeave Medical Billing Company will give the cardiology practices an outsourced, streamlined, and efficient revenue cycle management solution. By having expertise in cardiology coding, MedHeave provides overall assistance for revenue generation and minimization of denials using specific guidelines and regulations of the industry. Their team of seasoned billing professionals deals with filing all documents, such as claims submission, follow-up on payment posting, and denial management. 

Through the MedHeave medical billing partnership, a cardiology practice can be at ease knowing that their billing operations are in professional hands, leaving them to focus on the greatest patient care possible. MedHeave enables cardiology providers to maximize financial efficiency and sustain steadfast growth by leveraging customized solutions tailored to each practice’s unique needs. Feel free to Contact us at (888) 487-1178.

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