Staying Ahead: Cardiology Billing Compliance and Audit Preparedness
Cardiology practices often find themselves in a difficult position when coding for evaluation and management (E/M) services. Many of these services may be qualified as complex enough to be considered level 4 or even 5. But then, they end up getting down-coded as cardiologists become wary of Medicare audit triggers. And as a result, they leave a significant chunk of money on the table.
This is not to say that these practices do not follow E/M guidelines. Many of them comply well and document everything. But the auditors from authorities like the Office of Inspector General (OIG) remain a bit extra vigilant when looking for billing abuse, fraud, or waste. When they notice a cardiology practice getting too many high-level visits, they shortlist it for an audit.
But does that mean cardiologists must down-code even after justifiably providing complex services? The answer is NO. In fact, they can ethically increase their reimbursements while decreasing the chance of audits. All they need to do is ensure proper cardiology billing compliance. Although many cardiologists think of compliance as an intimidating process, it’s not that challenging.
In the lines below, we have discussed the ways to ensure effective compliance for ultimate audit preparedness.
Cardiology Billing Compliance Strategies
Establish An Internal Audit Plan
Internal audits help you ensure that your practice stays on the right track. It helps identify many issues, which you can rectify to stay on the correct course. These issues include:
- Coding mistakes
- Under-coding, over-coding, wrong modifier use, and unbundling
- Documentation errors
- Issues with reimbursements
- Non-compliance on the payer side
- Unintentional billing fraud
- Mistakes in claim scrubbing
You can work on the following basic auditing measures to prevent these issues.
Ensure Coding Compliance
Be sure to set high standards when measuring your coding quality. This auditing strategy will not just help determine coding errors but their root causes as well. It will also identify the strengths and weaknesses of your coding team.
Appoint An Auditor
Have a qualified and credentialed coding expert as your lead auditor for ASC coding procedures. And make sure they are certified in coding policies and guidelines. You may consult an ASC auditing company if hiring an in-house auditor is out of the question.
Set A Practical Frequency To Review
Initially, it may be hard to determine the frequency of internal audits. So, conduct a random review just to find out how many audits you will need in a year. Generally, it is best to go with quarterly audits and an annual audit.
Adhere To Coding And Documentation Guidelines
As a cardiology practice, you must have good knowledge of coding and documentation guidelines from CMS and AMA. And then, you must ensure that your billing team is up-to-date with the latest CPT, ICD, and other coding updates.
Ensure Diagnostic Coding Accuracy
The completeness of your reimbursements depends on accurate diagnosis. This makes diagnosis coding accuracy crucial. The specific codes for diagnostic services are called ICD codes, and they hold vital importance in cardiology billing. Therefore, be sure to stay on top of all ICD updates.
Set Immaculate Documentation Standards
Comprehensive and accurate documentation is crucial for establishing medical necessity for any procedure. One of the most effective ways to ensure this accuracy is to standardize documentation templates. This will create an easy-to-follow documentation pattern for the billing team. And as a result, they will be less likely to miss important details like patient history, medical examination, lab reports, treatment plan, and follow-up care.
Documentation standardization particularly benefits E/M billing processes where data accuracy is imperative. However, make sure that you use appropriate time-based documentation templates for this process.
Designate a Compliance Officer
This may sound like you must hire a specialized person just to check that your RCM adheres to set protocols. Sure, it can be an option. But it is not entirely necessary
A compliance officer is essentially a trustworthy person who can ensure your cardiology billing process remains on the right track. That can be anyone who can communicate well and guide your staff. He or she should have a strong personality and influence to ensure proper enforcement of compliance standards. If you already have such a person in your organization, fair enough.
However, it is worth mentioning that one person will not be able to manage everything if you are running a large practice. You will need a compliance team to ensure that your staff members and physicians receive proper education and that regulatory changes get taken care of. This team may consist of physicians, billing professionals, revenue experts, and health care attorneys. The major advantage of having such a diverse team is that everyone brings a unique perspective to the table. This makes it easy to pick the best solution in any specific situation.
Get Help From Technology
Using technology in medical billing is no more a luxury. It’s an essential requirement now. For high-end specialties like cardiology, incorporating technology becomes even more crucial. The most fundamental step towards this transition is EHR integration. This provides necessary automation in claim submission, reducing the risk of manual errors.
Another piece of billing tech that cardiology practices rely on is a scrubber. This software solution scrutinizes claims for documentation and coding errors and suggests fixes. This can take a significant burden off your shoulders and help with the process expedition.
And lastly, there are analytics and interactive reports that provide real-time insights. These features help cardiology practices look into their operations as well as provide industry insights. And the best part is that they allow you to pick your preferred KPIs to visualize custom reports
Final Thoughts
Medical billing for cardiology is naturally a tough undertaking. Its comprehensive documentation, intricate coding, and challenging compliance guidelines demand particular expertise and knowledge. Needless to say, strategizing holds the key to success.
At AltuMED, we provide expert services in cardiology billing. Our RCM experts work arduously to ensure your practice stays compliant with regulatory bodies as well as payers.
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