We are fast approaching the end of January and the point in the New Year when the majority of people's New Year's resolutions have already failed. This is, however, the time for renewed efforts to focus one's resources on achieving the desired goal. There are two keys to reaching your goals:

1. Do not view a minor failure (i.e., you just ate a quart of Ben and Jerry's Ice Cream) as final defeat (i.e., Well I might as well stop trying to give up sweets); and
2. Focus on a sequence of short term goals that make your larger goal seem more manageable (i.e., instead of "I will weigh 120 pounds by December 31st" set a series of goals such as "I will weigh 152  pounds by the end of February. I will weigh 148 pounds by the end of March." etc).

These ideas do not only apply to personal goals, but to business goals as well. If you are trying to improve your cardiology billing performance in 2009, you should build upon these concepts. So, given these two points what is the best way to achieve a New Year's resolution of improving your cardiology billing? The best place to start is with the goal of getting your claims out the door clean.  This is a great starting point because it does many wonderful things:

• This goal forces you to concentrate on the most critical elements of cardiovascular billing - gathering the proper information and using it to create a clean claim;
• It allows you to focus on achievable, smaller goals (85% of claims go out clean in January, 87% go out clean in February, etc);
• Set backs position you for better performance tomorrow. How? You look at the claims that did not go out the door clean and learn what went wrong. Do you have a problem at the front desk with gathering demographics? Do you have a problem with training your data entry people? Do you have one physician that consistently codes incorrectly? Do you have one payer that really dislikes one of your common procedures?
• Technology can be a powerful ally in achieving this goal. The use of coding tools, automated demographic verification tools and scrubbing claims will eliminate many sources of up-front errors that lead to claim rejections.

What does all of this mean? It means this is the time for a renewed focus on your cardio billing business goals. It is time to:

• Understand where you are starting your journey (what portion of your claims are accepted on first submission);
• Write down a powerful and meaningful performance improvement goal (my practice will have over 95% of its claims accepted on the initial transmission);
• Break them down into bite size pieces (I will improve clean claim submissions by 2% each month), and
• Adopt the mentality that you will learn from your mistakes.

This approach and focus can allow your cardiology billing efforts to reach new standards of excellence in 2009.

Copyright 2009 by Cardiology Billing Partners

If your are not aware and prepared for the 2009 cardiology billing and coding changes you may be leaving a lot of money uncollected.

Not since the mid 90's has cardiology seen such significant coding and billing changes as have been put in place in 2009.

Across the board the average Medicare fee increased just 1.1 percent. Cardiology in general fared worse than average, experiencing an average decrease of 2% due primarily to decreases in payments for in-office imaging.

Keep in mind the 2% reduction is an average number. Some practices will be well above this (especially heavy users of echo services) and others will actually see fee increases.

Here are examples of some of the upcoming changes:

- Sweeping changes in the codes for following up on implanted devices (sweeping as in all of the old codes are gone and the new ones have significant differences). The new codes include such things as specific codes or internet (remote) device checks, codes for devices with leads in 3 chambers, ICM device follow-up codes, and codes for periprocedural checks.

- 30 and 90 day global periods are now in place for follow-up for some devices. Also, the new codes are specific to either an interrogation evaluation or a programming evaluation. The codes are no longer dependent on whether reprogramming occurred.

- Wearable cardiac telemetry devices (for instance Cardionet type service) now have specific codes. You no longer bill with an unlisted code. These new codes include the complication of global periods.

- Codes that bundle multiple echo services under a single code have been introduced. Examples include a single CPT for bundling an echo with both a Doppler and color flow and a stress echo CPT that bundles both the stress test and stress echo.

As the examples above demonstrate, the magnitude of this year's cardiology billing changes are more significant that has been seen in recent years. Without proper education, cardiology billing training, software upgrades and billing resources cardiology practices may see marked reductions in collections and increases in AR.

To learn more visit the Cardiology Billing Partners website.

Copyright 2009 by Carl Mays II

Intentional and systematic inefficiencies in the insurance companies' medical reimbursement processes lead to inflated medical costs. Improved medical billing processes from providers and medical billing services can play a significant role in decreasing this component of healthcare cost.

Although the issue of claims processing is mentioned as one of the sources of rising healthcare costs, the true economic drivers that are keeping the current inefficient and opaque processes in place have not been well explored. The fact of the matter is that the current process prey's upon the technology, process and staffing limitations of most physician offices to take money from the physicians and give it to the payers. The result is rising costs and following revenues for the average medical provider.

Payers employ a series of complicated (and frequently changing) adjudication rules which medical providers and cardiology billing services must navigate to obtain payment for services rendered. Even when the maze is navigated successfully, payers will frequently (ten percent to twenty percent of the time) underpay claims. To add insult to injury, payers will also frequently simply "lose" claims that have been submitted. Unless the cardiology billing process is designed to catch these errors the payers never pay the money that is saved though the underpayment and misplacement of claims.

There is a strong economic motivation for payers to maintain the current inefficient billing process. They can increase their profits sharply since more than fifty percent of the claims they misplace or accidentally underpay are never noticed by medical providers.

The payers ultimately lose money on providers that catch the payer's mistakes and pursue the claim. It cost the payers about $25 each time one of these watchful provider's cardiology billing specialist calls the payer and speaks to a live person. To mange this cost, they payers have a system in place to make sure they pay the diligent practices properly while continuing to lose claims and underpay less watchful practices. They payers do this by grading each practice. If you are watchful you receive an A. If you are not catching the payer's errors you receive a F. A's are paid well. F's are not paid well.

So, how do all of these facts tie lead to the conclusion that better medical billing processes can lowering the cost of healthcare? If each and every underpaid or lost claim is pursued (which is what a well-designed medical billing process should do) then eventually payers will lose all economic incentive to play games and make the medical billing process complicated and expensive.

Imagine if every physician's internal billing department or cardiology billing company pursued every claim until it was paid in full. The payers would see their cost to adjudicate the claims rise and they would see their payments to providers rise because the lost/under paid claim games would no longer prevent providers from ultimately being paid. This combination would lead to each physician ultimately being paid quickly and without fuss because the insurance companies would lose significant money by playing games ($25 per extra phone call generated by the games) and they would gain nothing since payments would only be delayed, not avoided.

Many companies and individuals are dreaming of the day when the medical billing process disappears entirely and claims are adjudicated in real-time while the patient is standing at the checkout desk. In this system significant costs will be saved, but the system will never emerge until payers no longer have an incentive to play games with medical claims. Medical billing companies and medical providers can make this happen by insuring that all providers are rated A  in the eyes of each payer.

Copyright 2008 by Cardiology Billing Partners

The path from deciding to outsource your cardiology billing to selecting your medical billing company requires a well planned selection strategy. A cornerstone of this strategy is well thought out and executed reference checks.

There are many critical stops to make in the journey towards your cardio billing company selection. Reference checking is one of the most important stops along the road. There are several steps that must be taken to ensure through reference checking.

These elements include properly defining the type of references that will be meaning for you (e.g., geography, length as a client, number of providers, primary payers, etc), obtaining success and failures as references, determining with whom you wish to speak at the references, developing an interview guide for your reference calls, conducting the reference checks, synthesizing the results of the checks and making a final decision about the billing company. The main focus of this article is creating an effective interview guide.

An interview guide is your road map for the interview calls that insures you ask everything required to make a good decision. The first step in developing the interview guide is writing out the best and worst case scenarios for the potential billing company. With this in hand create a list of questions that will help you determine where along the spectrum between your two scenarios your potential medical billing service may lie.

It is critical to ensure that your questions are specific enough that you can come away with real facts from the reference calls.  You do not want to ask broad questions like "Are you happy with this company's performance?" Such questions are open to much interpretation and are driven by the individual's previous experiences.

You can overcome this problem by asking targeted questions that get to the root of what is important to you. If you really care about timely filing issues ask "How many times has this billing company missed a timely filing deadline?"

With your list of questions completed you need to put them in an easy to use form. The best approach is to print them out with about four questions spaced out on a page. This allows you to easily write the answers next to the questions. Do not make any calls until you do a final read through of your questions and ask yourself, "will I have what I need to make a final decision if I get these answers?" If the answer is "yes", then pick up the phone and start dialing.

It is critical not to allow a good meaning but talkative reference keep you from getting all of your questions answered. Make sure they know you have a pre-determined list of questions you need to address. Find out how long they have to speak with you and keep an eye on the clock to make sure you get all of the information you need. You should leave the door open for call backs by letting references know you may need to speak with them again.

One final tip: If during the reference check one of the references brings up a key issue you had not considered, add it to your interview guide and call back any references to which you have already spoken to get the missing data you need from them.

With your well planned and structured reference checks complete you will be in a position to make an informed medical billing service decision.

To learn more visit the Cardiology Billing Partner's Website.

Copyright 2008 by Cardiology Billing Partners.

Based on the experience of Cardiology Billing Partners there are four key elements to creating a world-class billing staff:

• Recruit, train and retain the best billing staff:
• The leading billing organizations recruit best staff.  A dedicated, specialized HR team evaluates applicants—applicants must pass a proprietary billing testing process assessing both skill and will. This process shouldn’t be different from the recruiting process of a Fortune 500 organization.
• The leading billing organizations train to develop desired quality.  Junior staff members must pass demanding training programs—junior team members are developed into billers, capable of following the measured and monitored billing process.  In addition, staff is trained throughout the year in latest payer rules, follow-up techniques and compliance guidelines.  A dedicated Compliance Officer is responsible for all additional HIPAA and OIG training.
• Best staff is retained; weak staff released.  The billing organizations staff is evaluated every year to assure proper development and progress.  Evaluations are based on tangible, measurable targets and quality indicators. Best performers are properly rewarded and lowest 10% of performers are asked to leave. This should be done methodically in an effort to continuously improved the quality of billing staff.

• Specialization of the billing team: The top billing organizations’ billing team is composed of dedicated specialists in demographic data entry, charge posting, follow up, and patient collections.   Each position is designed to excel in its role and is properly supervised and incentivized.

• Provide the staff with solid analytics support;  Besides providing the clients with continuous practice analytics focused on clients’ practice improvements (coding, contracting, profitability, marketing, etc) , the leading billing organizations’ Analytics Group should offer strong analytics support to the billing staff. The Analytics Group should trend and measure payers response times, rejection trends, payment rates ,etc in order to properly focus the billing staff.  They should also measure various elements of the internal billing process for continuous improvements.

• Incentives for billing staff: All positions in billing process are monitored and incentivized to perform optimally for your account. The incentive system while highly motivating for the staff, falls within the parameters established by the OIG for an acceptable incentive system in a medical billing environment.  The best performers should be rewarded accordingly.

If you would like to learn more please visit Cardiology Billing Partners' website.