Saturday, January 31, 2009

Cardiology Billing is No Place for Generalists

By Carl Mays II

Medical practices lose money every single day (often over 20 percent of their realizable income) because they are not utilizing medical billing specialists, technologies, processes and management that can compete with insurance companies.

As physicians are taking into consideration the use of medical billing services to stop the hemorrhaging of cash from their practices, they are faced with a broad range of options. On the diminutive end of the spectrum are home-based medical billers. On the opposite end of the spectrum are companies that employ hundreds of medical billers and have thousands of clients.

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.

With cardiologists facing ever increasing costs they must insure that money is not being left on the table because they have a billing company that is not a cardiac billing expert. Cardiologists must also be aware that that many billing companies that claim cardio billing expertise actually outsource their cardiovascular billing work to at home billers. Situations like this are fraught with risk since the remote workers are not working in a controlled and monitored environment.

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.

A typical shortcoming with medical billing services that do not specialize in cardiology billing is the inability to properly track and pursue insurance underpayments. These underpayments cost most cardiologists about 10% of their potential income. If a medical billing company does not understand the multi procedure rules and have a system that can track underpayments (and does not flag every payment on a second procedure as underpaid), they will find it difficult to capture this lost revenue is a systematic manner.

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 - 15246

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