Medical billing is a critical service that supports healthcare providers by submitting claims and collecting payments from insurance companies and patients. Medical billing specialists need to be experts to guarantee that the bills are in full and in a speedy manner. It is quite common for over 20% of a practice’s collectable revenue to remain unclaimed because of improper coding and ineffective collection tactics.
Medical billing outsourcing is a growing trend that medical practices and facilities are employing to level the playing field with insurance companies. Potential outsourcing options start with individual medical billers working from their home to medical billing services that with thousands of providers.
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.
The choice of an experience billing provider has become all the more important for cardiologists as they watch their cost rocket upwards. With their margins shrinking they must be confident that their medical billing service is collecting every dollar the cardiologist is owed. Selecting the proper medical billing service is made all the more difficult by the fact that many companies claiming to be experts in billing for cardiovascular practices actually do not do the billing themselves, but outsource the work to other vendors that are based in India or work from their homes.
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.
Good cardio billing requires the ability to track underpayments. This is more complicated than typical medical billing because of the rules around multiple-procedures. This complication often exceeds the capabilities of the billing software used by generalist billing companies. This is a critical failing since proper pursuit of underpayments can increase a cardiologist’s collections by 7 to 10 percent.
These billing complications extend to the patient collections arena as well. The patient collection process for specialists like cardiologists is more complicated because of the large patient balances often owed, the complexity of the procedures/EOBs that must be explained to patients that do not understand their bills and the older population cardiologists typically serve. A medical billing service with expertise in billing for cardiology knows how to deal with these situations. Billing services without such experience will increase the risk of both lower patient collections and upset patients confused about their bill.
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
