The already complex process of medical coding is becoming more challenging than ever. The large number of changes to cardiology billing codes alone demand a coordinated plan that addresses these modifications.
Cardiologists in hospitals, clinics and group practices have two primary options to avoid cardiology billing issues that might delay claim reimbursements.
- Implement an intensive training program for medical billing staff.
- Contract with a top third party medical billing firm to eliminate claims processing problems.
The complexity of integrating the new cardiology codes is enhanced by three additional issues.
- Some familiar codes are being deleted.
- Procedure and diagnosis coding involves a reclassification of some of the major arteries and vessels.
- Introduction of numerous "combination codes."
Coordinated, Intensive Training Program
The depth and number of changes to cardiology codes does not favor occasional training sessions. Even experienced medical billing staff can quickly descend into confusion when trying to learn new codes along with those codes that are deleted.
Therefore, your training program should include the following features.
- Evaluation of individual personnel knowledge and experience levels to establish a baseline starting point.
- Establish and schedule training classes--and stick to the schedule with no exceptions, except for medical emergencies.
- Prepare documentation for at least two training components:
- Refresher course on medical terminology and unchanged codes.
- Highlight specific code additions and deletions for special emphasis.
- Explain all changes to billing procedures, with emphasis on the "why" of the changes, and teach updates to the billing software you use.
- Prepare oral and written tests to measure staff retention of code and billing procedure changes.
Whether you use internal trainers or have a professional firm manage your cardiology code training program, these components should be included in the process. Skipping any of these features could result in staff that is insufficiently trained in cardiology code changes.
Third Party Medical Billing Service Company
Top third party cardiology billing companies may be the most effective way to implement the extensive cardiology coding changes. Consider the benefits these companies offer.
- Access to experienced medical billing professionals who have been trained at billing company, not practice or hospital, cost.
- Elimination of payroll taxes and benefits payable for and to your staff.
- Having billing personnel who are up-to-date with all added and deleted codes.
- Confidence in billing personnel knowledge level with using combination codes properly and understanding of new major vessel definitions.
Top, experienced firms have researched the major cardiology procedure and diagnosis changes. Major changes primarily affect four treatment categories.
- Ventricular assist device insertion and removal.
- Intra-cardiac electrophysiology ablations.
- TAVR/TAVI code modifications.
- Percutaneous coronary intervention (PCI) services.
The number of added and deleted codes for these primary treatment procedures will challenge most internal billing staff members, regardless of experience. A proven third party medical billing firm eliminates the training and claims challenges generated by these major cardiology changes.
Using a trusted third party firm also minimizes the inevitable management and financial challenges created by the necessity of intensive internal training and/or claims processing delays that follow. Hospital administrators and practice managers learn that the only "feature" they give up with third party billing firms is reimbursement delays, as they still retain control of claim submission timing and management.
New cardiology coding changes can confuse billing staff. For example, ventricular assist device changes include four new codes for common procedures plus at least two "additionally reportable procedures." Also, billing staff must use updated billing guidelines for these procedures to avoid reimbursement delays.
If you are committed to an intensive, thorough training program for internal staff, you may receive the same benefits. However, should training time be at a premium and reimbursement timing critical to your cash flow necessities, comparing the cost-benefit features of using a third party billing firm is valuable.
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