Cardiology Medical Billing Blog

Cardiology Billing Update: Hold Medicare Claims or Submit Them?

Cardiology Billing Partners — Wed, 16 Jun 2010 03:37:00 GMT

According to various media reports from Washington, action will come too late regarding the June 6 Senate announcement that it is ready to initiate a 19-month Medicare "doc fix." This means cash-flow problems will affect doctors across the country. Senator Charles Schumer (D-N.Y.) said at a press conference that the Senate is expected to have 60 votes to pass the bill "early next week (week of June 14)." But even if the votes come then, more than likely it will take several days for the bill to be passed by the House and signed into law by the President.

On Monday, June 14^th Medicare responded to this continued delay by Congress by deciding that it will extend its freeze on processing claims with June dates of service until Friday, June 18^th. It is possible that Congress will reverse the massive Medicare fee reduction by that date. Given, however, the time line outlined by Senator Schumer, it is unlikely the fix will be completed by that time.

So, on Monday, June 21^st, Medicare may well begin processing June 2010 claims using the 21.3% fee reduction that went into effect on June 1. However, it appears highly likely that within two weeks Congress will retroactively reverse the fee cut. This will result in Medicare claims being reprocessed, causing new "make-up payment" problems for providers. It is a situation that leaves providers to ask some important questions - and to make some important medical billing decisions.

Question/Decision #1: Should your cardiology billing department continue submitting your Medicare claims as usual - or should you hold them until Congress eliminates the 21.3% fee reduction?

If you submit your claims as usual, then you will receive payments as usual - but at the reduced fee rate. When Congress does eliminate the fee reduction, you will have a lot of work to do when Medicare reprocesses your claims. This work includes auditing to ensure Medicare has indeed made all of the make-up payments they should. It also includes responding to patients' questions and concerns about receiving two Explanation of Benefits (EOBs) from Medicare regarding their charges. The situation will be exacerbated when Medicare automatically crosses these lower-paid claims to secondary insurance payers. EOBs and payments involving secondary (and possibly tertiary) insurance payers will cause further confusion and complications for your office - and for your patients.

If you hold your Medicare patient claims and then submit them after Congress passes the "doc fix" bill, you will not get hit with the 21.3% cut - but you will get paid later than usual. You also will have a much simpler time in terms of ensuring all payments are correct from both Medicare and secondary payers. Also, patients will receive only a single EOB for the dates of service during this "waiting" time period.

Question/Decision #2: Should you collect co-insurance from Medicare patients under the fee schedule that was in place prior to June 1, 2010 - or under the significantly reduced fee schedule?

If you collect patients' 20% Medicare co-insurance under the reduced fee schedule and the reduction is reversed by Congress, then under Medicare rules you will need to bill patients for any extra amount they owe over $5.00. (You are not forced to try and collect balances that will cost more to pursue than will be yielded in revenue). This will lead to additional expense and patient confusion.

On the other hand, if you collect co-insurance amounts in accordance with the pre-June 1 fee schedule and Congress does not reverse the fee reduction, then you will need to reimburse patients any overpayments greater than $5.00. (The same financially reasonable principle applies to patient refunds.) Since it is unlikely that the fee reduction will stand, this is an unlikely outcome.

Question/Decision #3: Most likely, you have already filed some June 2010 Medicare patient claims. These will start being processed on Tuesday and will generate many of the issues mentioned above. (The decisions you make now regard being able to minimize the complications rather than being able to avoid them completely.) These already-filed claims force you to ask and decide: Should you bill patients and secondary insurance payers for the June 1 to June 14 dates of service you submitted (and for which Medicare will begin receiving payment over the coming days) or should you wait for these claims to be reprocessed and paid correctly after Congress reverses the 21.3% Medicare fee cut?

The pros and cons outlined for the questions/decisions in #1 and #2 also apply to #3. If you proceed with billing patients (and secondary insurances that do not automatically cross over), you will have confused patients who receive an initial statement from you and then receive a second statement from you for additional money after Congress retroactively reverses the fee cut.

On the other hand, not billing patients and secondary insurances until after Congress acts will delay your collections - but will lead to much less patient and office confusion.

My Recommendation: Every practice must make its own decision about these issues, but a decision must indeed be made. If you can handle the temporary cash flow reduction, then my recommendation is:

Hold your claims until Congress retroactively reverses the Medicare fee cut;
Collect patient co-insurance under the pre-June 2010 fee schedule;
Do not bill patients or secondary insurance for the June 1, 2010 to June 18, 2010 dates of service for which you will start receiving payments over the coming days. Instead, bill the patients and secondary insurances after these dates of service are reprocessed when Congress reverses the Medicare fee cut.

This approach will minimize confusion in the practice and among your patients. It will also minimize the chance you are underpaid for your claims.

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Cardiology Billing Update: July 6 PECOS catastrophe fast approaching

Cardiology Billing Partners — Sun, 13 Jun 2010 04:07:00 GMT

Until recently physicians believed that they had until January 3, 2011 to comply with Medicare's PECOS enrollment requirement. This is no longer the case. In May Medicare announced that a new mandate from the health system reform law forced the deadline to be moved up by 6 months. Starting July 6, 2010 if the physicians that refer to your practice are not properly enrolled in the Provider Enrollment Chain and Ownership System (PECOS) then your cashflow will be interrupted. If a claim is submitted to Medicare after July 6^th with a referring physician that is not enrolled in PECOS, then Medicare can reject the claim. This means that your practice needs to work with your referring provider base and ensure that your referring providers are enrolled in PECOS. This is a much higher burden than the more typical medical billing situation where a provider only needs to ensure the he or she is enrolled with a payer.

In order to mitigate any risk to your practice's cashflow you need to:

Generate a report of your top referring providers,
Call and check the PECOS system to confirm that your practice's key referrers are properly enrolled (you will need basic information about the providers such as name, tax ID or provider ID),
Contact any referring providers that are not properly enrolled with PECOS and make certain they know: 1) they are not enrolled with PECOS, 2) why it is critical that they enroll with PECOS, and 3) how to quickly enroll with PECOS (to eliminate any delays on their part in finalizing their enrollment), and
Send thank you notes to all of the providers that are enrolled with PECOS (this is a great way of showing them how much you value their referrals).

With all of the healthcare bills and Medicare cuts taking up mind share and discussion time, it would be easy to miss the critical PECOS medical billing deadline and find that the 21% Medicare fee cut is one of two big reimbursement problems. Take action TODAY to ensure your practice's cashflow.

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Cardiology Billing Problems? Survey Shows that a Cardiology Billing Company May be the Answer

Cardiology Billing Partners — Fri, 11 Sep 2009 08:02:00 GMT

A survey recently conducted by the Medical Group Management Association (MGMA) has unearthed information that many have been expecting for a while -- medical practices that rely on the services of a medical billing company enjoy several advantages over in-house billing solutions.

The survey found that for practices switching from in-house billing to a medical billing company:

73 percent of practices using medical billing companies reduce their AR;
The same ratio of medical practices experienced higher collection rates;
59 percent experienced fewer lost or denied claims;
59 percent enjoyed significantly better reporting and practice performance insights; and
46 percent enjoyed better productivity among staff.

These and other findings offer factual evidence that the majority of medical professionals and practices that utilize well-chosen medical billing companies experience broad improvements in performance and productivity.

Of course, medical billing companies do present many advantages over many in-house billing solutions.

Medical billing companies have more scale to purchase and deploy the technologies required to properly submit claims, battle with insurance companies and collect personal balances.
Medical billing companies also attract better and more efficient billing specialists, and keep such professionals on the roster more easily.
Medical billing companies keep a deep bench of employees, so their clients don't have to deal with the risk of losing a key billing employee from an in-house billing solution.
Medical billing companies tend to stay on top of developing industry technology better than in-house billing departments.
Medical billing companies have a broader view of the medical industry as a whole because they deal with many different medical professionals at the same time. This knowledge helps them deliver better services to their clients.

A copy of the survey is available from the MGMA's website.

Make 2009 Your Best Cardiology Billing Year Ever

Cardiology Billing Partners — Sun, 18 Jan 2009 10:10:00 GMT

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:

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
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.

Cardiology Billing in 2009 faces new challenges

Cardiology Billing Partners — Sun, 11 Jan 2009 05:33:00 GMT

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

Great Cardiology Billing Can Lower The Overall Cost of Cardiology Medical Services

Cardiology Billing Partners — Sat, 13 Dec 2008 19:56:00 GMT

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.

Cardiology Billing Can Profit From Today's Clean Claim Laws

Cardiology Billing Partners — Wed, 10 Dec 2008 23:32:00 GMT

Each state has passed a Clean Claim Law. The level of benefit these laws provide to medical practices and facilities starts on the low end with states such as South Dakota that provide little more than a slap on the insurance company's wrist to states such as Texas which levy substantial financial penalties on tardy payers.

Clean Claim laws can be a powerful medical billing tool because they are built upon the concept that insurance companies have a responsibility to quickly adjudicate clean claims. The typical law provides 30 days for a payer to process a clean electronic claim. To properly benefit from Clean Claim laws a medical billing company or medical practice must be capable of reliably and systematically keeping track of:

To which insurance companies does your state's clean claim law apply (some payers are exempt);
The date your practice initially submits each medical claim;
When a request for information was received from the payer (if you receive one then it stops the 30 day clock until you respond),
Events that restart the clean claim clock (e.g., your office replies to a payer's information request), and
When you received a payment or denial.

The design and implementation of the system and reporting can be challenging, but it can pay huge dividends in terms of the penalties from payers and in the way in which you will make payers take notice of your claims next time. You may actually find, as have other aggressive users of the clean claim law, that you will receive calls from payers assuring you they will process your claims quickly and asking you to please stop submitting complaints.

A quick way to get started with using the clean claim law is to pick a specific payer that you believe habitually delays claims beyond 30 days. Find a handful of claims that have gone past 30 days and then test the water with those claims. This will allow you to learn the basics of using the on-line tool provided for submitting complaints and see the impact of your initial complaints.

To learn how Cardiology Billing Partners can help you leverage your state's clean claim law please visit our website.

Cardiology Billing Tip of the day - Good patient collections are critical with bad debt on the rise

Cardiology Billing Partners — Tue, 09 Dec 2008 23:59:00 GMT

In a recent Transunion survey of hospital administrators, nearly half of the surveyed administrators say their hospitals have experienced a 6 percent to 10 percent increase in uninsured and underinsured patients since early 2007. Almost 30 percent observed an increase of 11 percent to 20 percent. The survey covered hospitals in 15 states.

More than 40 percent of respondents indicated they have bad debt percentages between 7 percent and 10 percent.

Other key survey findings include:

Nearly 79 percent of respondents said they are concerned that Consumer Directed Healthcare Plans will increase their bad debt within the next two years.
When ranking business objectives in order of importance, 43 percent of respondents said increasing collections at the time of service and post discharges were their number one objective, followed by improving operational efficiencies at 21 percent and decreasing bad debt at 18 percent.

It is there therefore supremely important to collect well form the patients. Clinics and practices need every tool available — basic and advanced — to streamline what is otherwise a very labor-intensive task:

Online payment technology is evolving—with some new technology the web sites now can accept credit cards as well as debit cards and even electronic checks.
Have more than one credit-card reader if you’re processing a lot of patients at the same time. If possible, install a card reader with a built-in check scanner to convert a paper check into an electronic one, debiting the patient’s account that much faster.
Establish a consistent policy on whether you’ll reschedule these patients or let them see the doctor and mail in their money later. If you choose the latter route, make it easy for patients to remember their responsibility. Hand them a self-addressed envelope marked “COPAY-URGENT”.
Tailor your follow-up based on the credit status of each patient. Your three basic categories could be — (1) insured, employed patients with a record of timely payments; (2) insured, employed patients with a spotty history; and (3) uninsured or underinsured patients. You might want to dispense with follow-up calls altogether for the underinsured or uninsured, but as part of your collection policy, you might help them sign up for Medicaid or charity resources from the get-go.
Track how well your front desk staff collects co pays and coinsurance. Reward and discipline accordingly.

To learn more visit the Cardiology Billing Partners Website.

Selecting Cardiology Billing Services Using Smart Reference Checks

Cardiology Billing Partners — Mon, 10 Nov 2008 22:34:00 GMT

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.

Cardiology Billing Requires Superior and Properly Motivated Employees

Cardiology Billing Partners — Fri, 07 Nov 2008 22:58:00 GMT

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.

Cardiology Billing Outsourcing Truly Puts The Biller In Your Corner

Cardiology Billing Partners — Thu, 16 Oct 2008 22:58:00 GMT

One of the key advantages of billing outsourcing is the clear alignment of incentives between the practice and the billing company.

The billing company only gets paid when the practice gets paid while the practice’s staff gets paid irrespective of results. There is also an incentive for the billing company to perform better—the better it performs the more it collects for the practice and in turn the more it earns (and vice versa). This is not true for in-house staff whose wages are fixed irrespective of performance and quality of work.

This issue, however, is often not fully understood or appreciated by many providers. These providers frequently say: “the staff works directly for me in my office-- they are more loyal and will do a better job and I can see what they are doing”. From our experience, this is simply not true.

I recently spoke with a partner at a busy cardiology practice. While one of the billers was out sick, some paperwork was required and the supervisor went out looking for it. When the supervisor opened the missing biller’s desk, a stack of unfiled, old claims was also discovered. It turned out about $40,000 of them were past timely filling deadlines. They were lost. I repeat—the practice lost $40,000! When the biller returned from her leave, she was “sternly” reprimanded. Let me say it one more time—she was reprimanded. No: not fired, but reprimanded. Either way, the practice lost $40,000 in just this one instance alone.

When I asked the doctor why a more severe action was not taken, he explained to me that "we already have staffing problems and did not want to alienate the billing staff any further.” The guilty biller was apparently moved to the front-desk role and is now responsible for gathering demographic information and money.

I also asked how it was possible that the billing supervisor missed that $40,000. Did they not reconcile charges and payments and track charges, payments and write-offs? To this the doctor replied that “their system did not provide this level of reporting and no such reports were ever given to him”. Since, the practice was using a new release of a major billing software, I know this system has such capabilities—it is just that either (1) no one knows how to use the system—that’s bad or (2) they just don’t want to bother—that’s’ worse! Just imagine how much money is probably lost there annually.

At Cardiology Billing Partners we deal with these issues methodically and comprehensively:

All the charges, payments and write-offs are visible to you. We track everything so no charges (batches, days or places of service, etc) can be missed.

If we have your charges and do not submit them properly--- Cardiology Billing Partners will reimburse your practice for what you would have been paid by the payers based on your allowable. What this means is that you never suffer financially if we drop the ball. Try to have your billers reimburse you if they drop the ball.

Cardiology Billing Partners also provide clients with access to our system so that they can see real time status of their account. We will give you client portal access to reports and dashboard functionality 24/7. At any time, you or your practice manager can go in and check status of claims, payments, patient balances, etc. No more excuses that “the system cannot do this”!

We often hear from the physicians how hard and long they work for ever decreasing reimbursements. All this is true. However, too often we also see practices (through various reasons) hurt themselves financially—over and over again.

No—your staff will not work harder for you just because you employ them; and no- the biller who lost you $40,000 will not do any better job collecting money and gathering information from patients. You will probably need to “sternly” reprimand them again.

A high performing cardiology medical billing company with complete transparency and full alignment of incentives is the surest path to medical billing excellence and strong financial performance for your cardiology practice.

To learn more please visit Cardiology Billing Partners’ main website.

Cardiology Billing and Revenue Cycle Denial Management

Cardiology Billing Partners — Tue, 07 Oct 2008 17:37:00 GMT

Revenue Cycle Denial Management has become a universal and often abused term in medical billing. Some use the term to describe a means of addressing claims denied for medical necessity. Others use the term to describe how some information is tracked for a specific payer, set of procedures or a place of service. Still others try to use it to describe what they do daily in the physician’s office.

If you were to ask your billing department or a current billing company (1) what is their Revenue Cycle Denial Management strategy; (2) what process do they use to methodically measure it and (3) what are the quantifiable results of it, you would most likely get a lot of blank stares.

Few billing departments appreciate the value a good Revenue Cycle Denial Management system can bring to a cardiology practice. A robust Revenue Cycle Denial Management system provides methodical management data for the billing process; the data are then used to (a) increase and (b) accelerate cash flow. The system accomplishes this needed service by tracking, quantifying, and reporting on every claim billed for which any payer denied the service. The reporting should be comprehensive, tracking all denials (not just selected denials). If used properly, the system can reduce first-time claim denials by over 50 percent. In our experience we’ve come across many practices with no way of monitoring if the payer is denying their claims at excessive or unwarranted rates, or even for what reason. These practices are probably losing 10-20 percent of their total revenue.

For an average three-provider cardiology group, that could be as much as $1.0 million dollars annually. What is typically missing from troubled billing operations is the lack of the management-reporting expertise needed to extract the data in a concise and meaningful way coupled with a lack of methodical, measured billing process needed to correct mistakes.

Cardiology Billing Partners' comprehensive Revenue Cycle Denial Management system has two main purposes. First, to provide feedback on why and how many claims are not being paid on the first submission to the respective payers. The second is to fix these issues. Cardiology Billing Partners' Revenue Cycle Denial Management software databases have been designed to track, quantify, and report on all denials for all payers. The standard output tracks, by payer, the number of claims denied and the reason for the denials. This is coupled with our Dashboard reporting for a quick visual management. With these unique reports our team can easily identify which payers are inappropriately denying claims; we can also compare these payers to their peers for proper trending and follow-up. The unique output for each practice allows us to refine the payer specific rules and build our own rules to prevent future payer denials. Payers that are chronic violators are pursued to resolve how and when they intend to process and pay outstanding claims. If the issues persist, there may be grounds to charge penalties stipulated by the Clean Claim Law (to the extent it exists in the state). Only by quantifying and analyzing the problem can you discover how to improve on the process. A real Revenue Cycle Denial Management system gives you a way to optimize and accelerate cash flow. Cardiology Billing Partners' system has a proven track record of improving revenues between 5-20 percent.

To lear more, visit Cardiology Billing Partners' website.

Three Keys To Sucessful Cardiology Billing Patient Collections

Cardiology Billing Partners — Fri, 26 Sep 2008 08:24:00 GMT

According to a recent Healthcare Finance News survey of 173 senior level finance and operations decision makers, 94 percent of responding executives say improving collections on patient payments is among their organizations' top three revenue cycle priorities. Improving patient collections is particularly critical for specialists such as cardiologists because the can easily reach and exceed having 20 percent of their practice’s potential revenue come from patient collections.

Proper patient collections require that you keep three things in mind: Time is not your friend, Technology is your friend, and A strong process is the foundation of success.

Time is not your friend

Cardiology Billing Partners has done analysis on thousands of patient collections efforts and found that the expected collections once a patient leaves the office fall dramatically. In fact, the expected collections if a patient does not pay within 28 days of the first patient statement fall below 10 percent. This means that you want to limit the amount of money you need to collect from patients and collect the money they do owe on or before the date of service whenever possible.

You achieve these goals when you always:

Have the front desk collect and verify patient’s insurance card and demographic information.

Have the front desk verify the patient’s insurance before the case to ensure they do have coverage for the date of service.

Perform pre-certification and never assume the procedure is covered.

Collect the co-pay and co-insurance at the time of the service.

Technology is your friend

Performing the task outlined above on a consistent basis is challenging. Proper use of technology can substantially increase your success rate. Key technologies include:

Performance Tracking

Make sure your billing/practice management system can support tracking of each front desk person’s quality of information gathering and co-pay collection frequency. If you cannot track and measure these metrics then you cannot improve them. Cardiology Billing Partners systems allows the tracking of individual performers and the financial impact of their actions. We have seen our clients use this to improve patient collections (and insurance collections) through a combination of merit-based bonuses, targeted training and replacement of poor performers.

On-line Insurance Verification

This is a powerful tool that improves patient collections and insurance collections by insuraing that claims go to the proper payer the first time.

Automated Calculation of Patient Responsibility

With all of the various allowables, multi-procedure rules, deductibles and secondaries, it is quite difficult for a front desk person to know how much they should actually seek to collect from the patients. Often this confusion results in the statement, “Don’t worry about paying today, we will just bill you after the insurance pays.” Your expected patient collections just dropped by 50 percent. Cardio Billing Partners deployed a custom built front desk checkout tool from CGI and has seen client performance improve dramatically. The tool tells the front desk personnel exactly how much to collect from the patient. When this tool is properly utilized, there is no patient balance remaining after the insurance pays (since it has all been collected at the time of service).

A Strong Process is the Foundation for Success

Having impressive technology and good intentions does not go far unless you have a well designed process that provides proper direction, monitoring, incentives and safety nets. A disciplined process properly allocates your efforts and fully utilizes your technology. Key elements include:

A merit-based incentive system that rewards your best performers. Few things will slow down front desk collection more than a well performing employee seeing a poor performing employee rewarded equally.

Focusing on the activities that have the most potential yield. If you asked your patient two or three times to pay and they have not—they will not pay on the fourth and fifth collection attempt. Do not dilute your efforts on lost causes.

Battling the true enemy: Time. Make sure all patients get a call after the first statements. This is actually your last opportunity to have a reasonable expected yield from patient collections. At Cardiology Billing Partners we moved our efforts from sending three statements and a letter to sending one statement followed by a phone call and saw a more than doubling of the overall patient collection yield.

Proper application of solid patient collection approaches will lead to higher collections, happier patients (sine they are not still dealing with invoices and collection notices months after their visit or procedure) and a much healthier bottom line.

For more information visit Cardiology Billing Partners website.

Cardiology Billing Sees Strong Results From Claim Scrubbers

Cardiology Billing Partners — Wed, 17 Sep 2008 21:42:00 GMT

One of the most important things in billing is to create and follow a very structured plan that can be measured each step of the way. Remember, if it cannot be measured and monitored it cannot be improved!

Clean claim submission can reduce average days in AR to less than 45 days

The leading cardiology billing operations utilize scrubbers that ensure your claims are clean before they are submitted to payers. These scrubs accelerate the speed of collections by avoiding denials and delays. They also increase collections by minimizing the volume of “re-work” and allowing billing staff to focus their efforts on pursuing true collections improvement opportunities and not simply resubmitting claims that should have been paid the first time. As a result of these scrubbers, over 90% of claims submitted are paid upon first submission. These “scrubbers” include:

Basic mechanical scrubber that assures that all claim fields have been properly filled with formatted data (social security number with 9 digits, date of birth etc), the NPI is in a proper field, there is a referring physician if needed, etc.
Scrubber that checks coding, bundling, and procedure information versus local Medicare and CCI rules. This scrub assures better coding, identifies overlooked procedures or codes.

The truly great cardiology billing specialists can rely on cardiology specific know-how and business intelligence created over time through work with many cardiovascular specialists in the given payer relevant geographic area.

Dynamic Proprietary Rule scrubber that checks for optimal coding and documentation versus the particular payer or plan’s rules. This scrub assures that each claim is optimized for clean submission. When the payer or plan’s rules change or when the billing office detects a systemic issue they can update the scrubber to filter and fix problems before claims go out. These specialized cardiovascular scrubbers can make a significant collections difference.

At Cardiology Billing Partners we have found that these actions can decrease the medical practice's collections cycle by up to 40-50 days. This is why you need to insure this critical step is being completed no matter who is doing your Medical Billing.

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

Cardiology Medical Billing Companies Must Fight Underpayments

Cardiology Billing Partners — Sun, 07 Sep 2008 03:45:00 GMT

If you make the decision to outsource medical billing, then make sure your medical billing company compares your payments to your allowables. It goes without saying, that if you do billing in-house the comparison still should be done. One of the advantages a specialized Cardiology Medical Billing Service has is that it sees payment information and patterns across many cardiologists for many payers. This allows cardiovascular billing services that regularly and systematically compare payments to contractual allowables to spot patterns that a single practice might miss. One that is seen at Cardiology Billing Partners on a regular basis is the systematic underpayment of claims by payers. As we look across multiple cardiologists we will see the exact same CPTs being underpaid by the same amount by the same payer in a given month across all of our clients. The following month we will see the same payer switch to underpaying a different set of CPTs. These under payments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice. The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount "under the radar" can make this difficult for an individual practice to spot. It is also difficult for a generalized medical billing service to spot if they are not comparing your payments to your contracted rates. At Cardiology Billing Partners we have found that this single action (comparison of payments to allowables) can increase a medical practice's collections by 5 to 10 percent. This is why you need to insure this critical step is being completed no matter who is doing your Medical Billing.

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

Cardiologists need a specialized cardiovascular billing service

Cardiology Billing Partners — Fri, 05 Sep 2008 05:48:00 GMT

Medical billing is a crucial health care service that supports physicians by submitting and collecting the payments from insurance companies and patients. One needs to be an expert to ensure that the bills are collected fully and in a timely fashion. It is quite common for over 20% of a practice’s potential revenue to remain unclaimed because of improper coding and weak collection strategies. Outsourcing medical billing is growing in popularity as an approach for addressing this tremendous loss of practice income. The range of outsourcing options runs from extremely large organizations to individual freelancers who work from home to provide medical billing services.

Medical billing is a highly complex area and it requires experience-based knowledge and expertise to contend with insurance companies. When it comes to cardiovascular billing, the situation gets even more complex. Such complexity can be handled only by a company that is staffed with well trained cardiology billing professionals. The medical billing specialist must be familiar with the specific codes and rules that make up the world of cardiac billing. Cardiovascular coding and cardio billing cannot be done by everyone, it is a highly specialized field and it is not possible to be successful in collecting the bills fully from the insurance companies without the proper skills and training.

As the cost of providing cardiology related healthcare services continues to rise, medical institutions and cardiology practices cannot afford to leave revenue uncollected by billing companies or freelancers that are not knowledgeable in cardio billing. It is also important to keep in mind some companies may promote themselves as large cardiac billing service providers but in reality they sub-contract the cardio billing to freelancers who work from home. Hiring such companies will lead to lost revenue because of the lack of proper process, controls, and training.

One of the major drawbacks of hiring a company that does not specialize in cardiology billing is their lack of familiarity with the procedures and the terminologies used. Even if the medical billing company serves one or two cardiologists, they will lack the depth and breadth of expertise required for successful cardiology billing. Moreover if the hired company does not specialize in cardiovascular billing, then they will not have the expertise to effectively appeal denied claims or answer questions raised by the insurance companies. A company that does not encompass a wide range of cardiology billing experience will find it difficult to track underpayments since multiple procedure rules, nuclear camera rules and cardiology procedures have significantly more complicated contractual adjustment rules than a typical family doctor or internist’s claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in cardiology billing.

These billing complications extend to the patient collections arena as well. The patient collection process for specialists like cardiologists is more complicated because of the large patient balances often owed, the complexity of the procedures/EOBs that must be explained to patients that do not understand their bills and the typically older population cardiologists serve. A medical billing service with expertise in cardiology billing knows how to deal with these situations. Billing services without such experience will increase the risk of both lower patient collections and upset patients confused about their bill.

To avoid all these billing related pitfalls cardiologists need to utilize specialized cardiology billing services. It is not advisable for an internist to perform cardiac surgery, similarly someone without training in cardiovascular coding and cardiology billing is not qualified to offer reliable billing services for cardiovascular practices. To learn more please visit Cardiology Biiling Partner's main website.