Billing Services

Reduced reimbursement, complex coding regulations, obscure claims submission rules, and increased staffing expenses make an outsourced billing service attractive to many cardiology groups. To run a successful practice, you need to minimize expenses while still knowing that you are collecting every dollar you’ve earned.

CardiologyCoder.Com is excited to offer a truly comprehensive billing and compliance solution for your practice. We stand out from other potential solutions by offering a unique combination of philosophy, expertise, service, and competence.

Focused on cardiology – The challenges of technology management, data capture, claims submission, accounts receivable follow-up, and staff recruitment are much more acute in cardiology practices. Focusing only on cardiology allows us to maintain our level of expertise and provide you with the highest quality services.

An aligned fee structure – We price and structure our services in a way that incents us not only to provide you with value, but also to excel on your behalf.

A proven transition process – We excel at creating smooth transitions that don’t interrupt our clients’ cash flow. Our goal is to ensure a seamless transition where staff are fully trained and where all interfaces and processes work.

Industry leading denial management expertise – Every health care provider deserves and expects to be paid. However, payers continually find reasons to deny, underpay, or delay payment. In the typical practice, up to 20 percent of rejected claims are never resubmitted. Our proprietary denial management software quickly identifies unpaid or inaccurately paid claims and prioritizes them for follow-up. The combination of this technology and an aggressive billing staff quickly stops revenue leaks and allows you to track payment and denial patterns in ways that ensure maximized collections.

World Class Compliance Initiative – Jim Collins, President of CardiologyCoder.com will develop, implement, and maintain a Compliance and Revenue Enhancement (CARE) package of services for you. There are three primary benefits offered by a CARE package:

Charge Capture: The expansion of service lines offered by today’s cardiology practice has been outpaced only by the complexities associated with billing for these services. Without staying on top of these complexities, practices forfeit much of their hard earned money. The auditing, monitoring, and training components of a Compliance Program frequently identify opportunities to increase revenue.
Regulatory Exposure: The regulations that have been developed and revised in recent years have created a hazardous work environment for all physicians and practice administrators. Penalties in excess of fifteen thousand dollars per claim have been established for inappropriate billing and the definition of “fraud” now includes operating a practice in “deliberate ignorance” or with “disregard of the regulations.” A compliance effort will proactively screen for violations of applicable regulations and give us an opportunity to correct identified problems before it is too late.
Insurance: The complexity and volume of federal and state regulations virtually guarantee that no physician group will be fully “compliant” with all applicable regulations one-hundred percent of the time. Excessive penalties (civil and criminal) are frequently imposed on organizations that appear to be practicing with disregard for applicable regulations. Maintaining an effective Compliance Program will help reduce penalties in the unfortunate event of prosecution by clearly illustrating the good will of the organization. This will help lower the organization’s culpability score and directly reduce potential penalties.

These benefits and more will be realized by your practice through maintaining an effective Compliance Program. The nuts and bolts of what constitutes a Compliance Program are typically reduced to writing in a plan document that must include seven specific functions defined by the Department of Health and Human Services Office of Inspector General. One of the first goals Jim would have in working with your organization would be to make sure it has a plan document that includes these government mandated specifics.

However, what make a Compliance Program effective are the actions we will take to identify, eliminate, and prevent activity that exposes you to liability. At the same time, one of the common benefits of a Compliance Program is that organizations frequently identify under billing (procedural and E&M services). These incidences of under billing represent opportunities to increase revenue and establish a Compliance Program as an “investment” rather than an “expense.”

AUDITING:

Two procedural audits will be conducted at even intervals through the year; the services included in this audit will be dictated by your unique CPT code utilization profile and designed to include a representative sampling of the major services provided.
Two evaluation and management specific audits will be conducted at even intervals during the year. These will also include a representative sample of visits for each provider; a mix of office based and hospital based services.
Quarterly physician dashboards will be compiled. These unique graphic analyses compare your billing profile to other cardiologists. This is similar to the assessment utilized by Medicare auditors to identify audit targets; the insight you’ll gain could help you avoid the audit radar.

Findings and recommendations from each audit will be conveyed in graphic-rich written reports. These reports are “physician-friendly” and convey a lot of critical information in a very efficient manner. They will allow you to view findings at the mile-high level and to dive into patient-by-patient detail where desired. Each report will also contain the source documentation (i.e. medical records) used in the audit.

TRAINING:

Web conference training will be provided to you and the appropriate support staff in your office and at the billing office after the conclusion of each audit. This training will be designed to cover any concerns identified during the audit and will include several case studies illustrating proper and improper coding and documentation practices.
Jim also works closely with you to develop an effective and accurate charge capture system: encounter forms, super bills, cross check mechanisms, internal controls, etc… The charge capture process will help ensure accurate billing and it will substantially minimize avoidable claim denials.

SUPPORT:

Mr. Collins will serve as the Compliance Analyst for your organization and be available to answer coding/billing questions, assist with coding for complex cases, and help research coding/billing rules. He will also assist you with responses to audits conducted by outside payers to help protect the interests of the organization.

Call Jim Collins (518-587-7780) or e-mail (jim@cardiologycoder.com) to discuss your needs and how we can partner with you in the future.