In the day-to-day operations of a cardiology practice, patients are seen, superbills are generated, revenue is collected, and…denials are received for a variety of reasons. Unfortunately, 65% of those returned claims are never reworked, corrected, or resubmitted, and the revenue is lost forever.
Equally frustrating is the MGMA report stating that 90% of denials are preventable. So how do you combat this ongoing problem – with a prevention-focused denials management strategy that includes best practices throughout the patient’s visit to ensure accurate and viable claims are generated and collected, and revenue that’s due finds its way to the bottom line.
Improving Cardiology Reimbursement through Automation
Performing a thorough and comprehensive audit from patient scheduling and intake procedures, through the clinical visit and check out, and finally through the coding, claims submission, and payment resolution phase, will give your practice a good idea of where things are running smoothly and where a little polish is required. It’s an operationally sound process to engage in quarterly or whenever there is an unusual change of procedure, i.e., an employee out on extended leave.
Top Three Ways to Automate for Efficiency and Clarity
In seeking to reduce denials, cardiology practices have the opportunity to explore new ways that efficient automation can expand their revenue, reduce their days outstanding in AR, and improve their patient’s experience by reducing surprise bills. Let’s look at three areas where denials originate and how automation might reduce their impact:
Prior Authorization
When patients initially present for service in cardiology, there is often a prior authorization (PA) requirement. Most practices still rely on antiquated manual processes to initiate, submit, and follow up on their PAs. There is significant room for error when managed manually, and this often leads to denials.
By introducing an automated system that uses Artificial Intelligence (AI) driven software, the PA process is handled in real-time with approvals available almost immediately in most cases. With this type of automated system, cardiology patients can be scheduled efficiently, denials can be reduced, and the PA administrative costs are reduced to a minimum.
Coding
Inaccurate or inappropriate CPT and ICD-10 coding is often part of why a claim is denied. Whether a code doesn’t demonstrate medical necessity or has the wrong modifier, it can impact the amount that you receive for the work that you’ve done. Secondarily, the sheer time and effort it takes to stay current on coding can be overwhelming, i.e., proper modifiers for the new CDSM criteria that are impacting cardiology Medicare patients as of 1/1/2020.
Exploring the benefits of a scalable, cost-effective third-party coding partner may be the ideal solution. Utilizing the services of a coding specialist through an automated bi-directional system allows you to rest assured that this important function is being handled by an expert that is up to date on the latest trends and changes with unmatched proficiency and expertise.
Denials Management
Finally, for the inevitable denials that you may still receive, leveraging an AI-driven solution would allow you to capture more revenue and ensure that each denied claim was being identified, evaluated for collectability, processed, or appealed as necessary. Best-in-class technology uses predictive rules based on payer guidelines to determine the next best action and implement a recovery strategy using the minimum of administrative effort but yield the maximum revenue capture.
Today, a strong and healthy cardiology practice relies on state-of-the-art operational processes to ensure maximum revenue reimbursement. With the ongoing changes in the healthcare industry, being up to speed on technological advances allows your practice to meet revenue challenges head-on.
Contact us to schedule a demo to learn more about maximizing your cardiology revenue!
