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How Cardiology Medical Billing Reduces

Claim Denial

Billing denials have cast a long, menacing shadow over the healthcare industry, resulting in both operational and financial inefficiencies for medical practices. Recent data from the Healthcare Information and Management Systems Society (HIMSS) paints a grim picture – an astonishing 76.1% of healthcare leaders have identified claim denial as the most formidable challenge they face. For those in the field of cardiology, this challenge is all too familiar. By the time a cardiology medical billing claim is denied, medical practices have already invested valuable time and resources, only to encounter the need for further appeals and a protracted waiting period for reimbursements. It’s a frustrating and costly issue, but it can be mitigated. This article delves into the heart of the problem, exploring the common reasons for cardiology billing denials and providing a comprehensive guide on how to prevent them.

What Causes Cardiology Billing Denials?

Cardiology billing denials can be attributed to a range of factors, each with a significant impact on the claim adjudication process. Familiarizing yourself with these common culprits can be the first step towards more successful cardiology medical billing:
  1. Incorrect or Incomplete Documentation: Adequate documentation is the foundation of any successful claim. Inaccurate or incomplete documentation can lead to claim denials, creating additional administrative work and financial losses.
  2. Illegible Handwriting: In the case of manually submitted claims, illegible handwriting can cause confusion and errors during the claim processing, increasing the likelihood of denials.
  3. Incorrect Coding: Accurate coding is vital for the success of cardiology billing. Errors or discrepancies in the codes used can result in denials and delayed reimbursements.
  4. Missing Modifiers and Combination Codes: Cardiology billing often requires the use of specific modifiers and combination codes for accurate claims. Neglecting to include these can lead to denials and financial setbacks.
  5. Failure to Obtain Preauthorization: Certain cardiology procedures may necessitate preauthorization from the insurance provider. Neglecting this requirement can result in claim denials and significant delays in reimbursement.

Preventing Cardiology Medical Billing Denials

Achieving a high clean claim rate is the ultimate goal for medical practices, as outlined by the Medical Group Management Association (MGMA). A clean claim is one that is processed accurately the first time, without denials or the need for additional work. While the ideal clean claim rate is 95% or higher, most practices struggle to surpass the 75% mark. Even for a smaller practice submitting 2,000 claims with a 10% denial rate, this translates to 200 denied claims. According to MGMA, reworking a single denied claim can cost between $10 and $25. Hence, addressing the root causes of claim denials is imperative.

Avoid Late Filing: The Importance of Timely Submission

The first strategy in preventing cardiology medical billing denials is to avoid late filing. Timely submission of claims is essential to meet payer requirements. To achieve this, follow these best practices:

  • Familiarize yourself with payer-specific timely filing limits for claims submission.
  • File fresh claims daily, avoiding a backlog that can lead to errors.
  • Promptly appeal denied or rejected claims before the deadline.
  • Utilize electronic claim submission software to reduce the risk of late filing and improve efficiency.

Enter Correct Patient Information: The Devil is in the Details

Accurate patient information entry is paramount in preventing cardiology billing denials. Mistakes in patient data can lead to claim denials, so it’s crucial to ensure accuracy. Consider implementing an Electronic Health Record (EHR) system to streamline patient information management. Some key areas to focus on include:

  • Double-checking patient data, including date of birth, name or spelling, and subscriber number.
  • Utilizing an EHR system for efficient and secure patient data management, updates, and sharing.
  • Minimizing repeated paperwork and reducing the chances of errors through streamlined data management.

Minimize Coding Errors: The Key to Accurate Billing

Accurate coding is pivotal in achieving success in cardiology medical billing. Cardiology practices face specific coding challenges, including incorrect or deleted codes, missing modifiers or combination codes, and issues related to specialty-specific coding. To minimize coding errors, follow these steps:

  • Stay up-to-date with the latest CPT, HCPCS, and ICD-10 CM and PCS code books.
  • Subscribe to newsletters from authoritative sources like the American Heart Association (AHA) to stay informed about recent updates and changes.
  • Regularly check for updates with the Centers for Medicare & Medicaid Services (CMS) and local regulatory bodies.

Check Insurance Coverage: Navigating the Complexities

Verifying patient insurance coverage is a crucial aspect of preventing cardiology medical billing denials. Whether you’re providing services to returning patients or new clients, understanding their insurance coverage can prevent denials caused by:

  • Pre-existing conditions.
  • Lifetime benefit caps.
  • Changes in employer or insurance plans.
  • Network status (in-network or out-of-network provider).
  • Exclusions of cardiac tests and services from the plan.

Avoid Duplicate Filing: A Systematic Approach

Beware of duplicate filing claims for the same individual, during the same visit, and for the same service. Duplicate claims can lead to denials and may even trigger an audit. To prevent this, consider implementing the following steps:

  • Conduct periodic audits to identify and remove duplicate claims.
  • When appealing a denied claim, ensure that necessary corrections are made to avoid duplicate billing issues.

Use Diagnoses and Signs/Symptoms Codes Judiciously: Following Guidelines

Following guidelines for the use of diagnoses and signs/symptoms codes is essential in cardiology medical billing. According to the 2019 ICD-10-CM Official Guidelines for Coding and Reporting, it’s crucial to report confirmed diagnoses if available and avoid using signs/symptoms codes when a definitive diagnosis has been established. Ensure compliance with these guidelines to prevent denials.

Seek Pre-Authorization When Needed: Avoiding Unnecessary Denials

Many cardiology procedures, such as ‘pacemaker installation,’ ‘electrophysiologic studies,’ and the implantation of hemodynamic monitors, require preauthorization. To avoid claim denials, it’s essential to verify the preauthorization requirements with the insurance provider and obtain preauthorization when necessary.

Ensure Complete & Accurate Documentation: The Foundation of Successful Billing

Incomplete or incorrect documentation can lead to time-consuming rework, revenue loss, and the risk of payer audits. To prevent these issues, it’s crucial to prioritize complete and accurate documentation. Consider the following:

  • Ensure thorough and accurate documentation and transcription, avoiding shorthand notes that can lead to confusion.
  • Implement an Electronic Health Record and Practice Management System to achieve higher accuracy in documentation.

Optimize Revenue Cycle Management Software: Streamlining the Process

Utilizing advanced revenue cycle management software can significantly reduce administrative errors and billing denials. For instance, OmniMD offers solutions tailored for cardiologists and specialty healthcare providers, including features like alerts, automated predictive analysis to flag potential denials, and a preauthorization tracking module. Consider adopting efficient Electronic Health Record and Revenue Cycle Management software to enhance your claims filing experience and minimize revenue cycle gaps.


Cardiology medical billing denial is both unnecessary and avoidable. With the implementation of best practices and effective revenue cycle management software, your practice can achieve a higher clean claim rate and significantly reduce denials. To streamline your cardiology billing process further, consider partnering with a professional medical billing service like DSO Med Plus. With their specialized expertise in cardiology medical billing services, you can ensure efficient claims processing, reduced denials, and improved revenue cycle management. Don’t let billing denials haunt your practice – choose DSO Med Plus for a seamless and successful cardiology billing experience. Take the first step toward achieving a higher clean claim rate and a more prosperous cardiology practice today.

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