Unexpected Claims Denials Procedures for Cardiologists

If you’ve been reading our blog you know that lately I have done some posting that focuses on different areas of medicine. This week I would like to focus on cardiologists and how there are several things in medical billing that can result in claim denials for your practice, and how outsourcing can help.

According to industry reports there are an estimated 80 million Americans who have one or more types of heart disease. Due to the fact that there are several complexities in the job of a cardiologist, the same is seen in cardiology billing. An estimated 20% of cardiologist the claims are denied by payers the first time they are submitted – and it is due to the following five reasons.

1. Illegible Claims

At this time most payers are accepting electronic claims but there are still a few that require manual submissions. Due to the fact that the payers scan paper claims into their systems, it is very important for the cardiology billing staff to ensure the readability and completeness of all claims forms before they submit them to the insurance company.

Outsourcing to a medical billing and coding company will ensure that all forms are complete, and legible so that you will not be denied payment by insurance companies.

2. Preauthorization

Did you know that many physicians have difficulty determining which tests and procedures require preauthorization by insurers? Physicians spend an average of 20 hours per week dealing with preauthorization – which in my opinion is a complete waste of time.

Many cardiologists lose out on their claims settlement by failing to abide by the preauthorization requirements of insurers. An outsourced cardiology billing service provider can make a list of the payers that require authorizations. Then is a service or treatment is prescribed, they can check the list to determine whether or not preauthorization is necessary. This will eliminate mistakes and loss of income for the physician (and his/her practice)

3. Incomplete Codes

An important thing that coders need to understand is that cardiology billing claims should be coded to the maximum number of digits for the code which is being used. The reason for this is because it is the best way to reduce denials – the longer the code the better the detailing. The problem is that several billers are minimally educated or not trained well enough which means that practices need the presence of billing experts who are aware of the recent codes.

Outsourcing billing will give you peace of mind because billing companies know the proper format (as well as abbreviated codes), and will submit so that your practice is reimbursed properly.

4. Duplicate Claims

This is one area that not a lot of physicians consider, and it looses them a lot of money every year. Insurance companies often deny claims due to ‘duplicate’ billing (in their terms).

To put things in perspective – if a patient was operated on for the same reason twice in the same week the code for the procedure is the exact same in both the cases. What happens then is that the payer can mistake one of the claims as a duplicate and deny it.

The problem is that a lot of in-house billing staff fail to add new information to the resubmitted denial which results in the payer assuming that it is a duplicate claim. There are also some practitioners may lose out on revenue if the two operations are considered to be duplicates by the in-house biller’s and a claim is never sent to the payer at all.

Outsourcing will eliminate these issues, because billing and coding companies pay close attention to all transactions and make sure that the correct information is there so that payers are not confused by what they think is a “duplicate claim”

Park Medical Billing is a cardiology billing service provider that will help you take the proper steps to make sure that all submissions are correct and no revenue is lost due to mistakes. Our billing experts are always available to help with any questions or concerns and will provide comprehensive billing solution to improve cash inflow and curtail denials.

Give us a call at 1-201-585-7306 or contact us for a free live demo today!

Share Posts

Share on facebook
Share on twitter
Share on linkedin
Share on pinterest
Share on email
Share on print


Leave a Reply

Your email address will not be published.