Medical practices lose money every single day (often over 20 percent of their realizable income) because they are not utilizing medical billing specialists, technologies, processes and management that can compete with insurance companies.
As physicians are taking into consideration the use of medical billing services to stop the hemorrhaging of cash from their practices, they are faced with a broad range of options. On the diminutive end of the spectrum are home-based medical billers. On the opposite end of the spectrum are companies that employ hundreds of medical billers and have thousands of clients.
In thinking through the billing options available, it is essential to understand that medical billing is complicated and requires deep expertise and expansive experience. When a specialty is involved, such as cardiology billing, the requirements for success become even harder to realize. Success requires that the medical billing company have a team that is knowledgeable in the complex rules utilized by insurance companies to judge cardiologists’ medical claims.
As the cost of providing cardiovascular 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 cardiovascular billing. It is also important to keep in mind some companies may promote themselves as large cardiology billing service providers but in reality they sub-contract the cardiac 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.
A key battle ground in the struggle to collect all of the money due a cardiologist is appealing denied claims and answering extremely specific and technical questions about procedures and diagnoses. Success In this arena requires significant experience, the kind that is only gained from serving many cardiologists for many years.
A typical shortcoming with medical billing services that do not specialize in cardiology billing is the inability to properly track and pursue insurance underpayments. These underpayments cost most cardiologists about 10% of their potential income. If a medical billing company does not understand the multi procedure rules and have a system that can track underpayments (and does not flag every payment on a second procedure as underpaid), they will find it difficult to capture this lost revenue is a systematic manner.
The cardiology-driven difficulties of medical billing encompass patient billing also. A cardiologist’s patient balance process is more challenging because most of the balances are quite sizeable. Coupling this with the difficulties of explaining to a patient their complicated Explanation Of Benefits and the cardiovascular terminology on their bills drives the need for patient collection specialists that have a strong expertise in cardiac billing. If patients are not handles with care then cardiologists will see their patient collections fall and their patient complains rise – not a good combination.
To avoid all these billing related pitfalls cardiologists need to utilize specialized cardiovascular billing services. It is not advisable for an internist to perform heart surgery, similarly someone without training in surgical coding and surgical billing is not qualified to offer reliable billing services for cardiologists.
Copyright 2008 by Carl Mays II
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