Tuesday, January 20, 2009

Cardiology Billing is No Place for Generalists

By Carl Mays II

Medical billing is a critical service that supports healthcare providers by submitting claims and collecting payments from insurance companies and patients. Medical billing specialists need to be experts to guarantee that the bills are in full and in a speedy manner. It is quite common for over 20% of a practice's collectable revenue to remain unclaimed because of improper coding and ineffective collection tactics.

Medical billing outsourcing is a growing trend that medical practices and facilities are employing to level the playing field with insurance companies. Potential outsourcing options start with individual medical billers working from their home to medical billing services that with thousands of providers.

Although the complexity of basic medical billing is quite high, it pales in comparison to the complications that come to play for cardiology billing. Successful navigation of the payers' policies and procedures for paying surgery claims requires specialized knowledge that comes from experience with billing for cardiologists.

The choice of an experience billing provider has become all the more important for cardiologists as they watch their cost rocket upwards. With their margins shrinking they must be confident that their medical billing service is collecting every dollar the cardiologist is owed. Selecting the proper medical billing service is made all the more difficult by the fact that many companies claiming to be experts in billing for cardiovascular practices actually do not do the billing themselves, but outsource the work to other vendors that are based in India or work from their homes.

A key battle ground in the struggle to collect all of the money due a cardiologist is appealing denied claims and answering extremely specific and technical questions about procedures and diagnoses. Success In this arena requires significant experience, the kind that is only gained from serving many cardiologists for many years.

Good cardio billing requires the ability to track underpayments. This is more complicated than typical medical billing because of the rules around multiple-procedures. This complication often exceeds the capabilities of the billing software used by generalist billing companies. This is a critical failing since proper pursuit of underpayments can increase a cardiologist's collections by 7 to 10 percent.

It is not only insurance billing that is more complicated for cardiologists; patient billing is also more difficult. The patients often have high balances, complicated explanations from their payers and do not understand all of the invoices they are receiving from their cardiologist. A billing company that has strong cardiology billing experience has spoken with patient about such statements many times before. A less skilled patient collection effort could leave the cardiologists with less money and unhappy patients.

To avoid all these billing related pitfalls cardiologists need to utilize specialized cardiovascular billing services. It is not advisable for an internist to perform heart surgery, similarly someone without training in surgical coding and surgical billing is not qualified to offer reliable billing services for cardiologists.

Copyright 2008 by Carl Mays II - 16036

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