Thursday, January 22, 2009

Every Cardiologist Deserves a Cardiology Billing Service

By Carl Mays II

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.

Although the complexity of basic medical billing is quite high, it pales in comparison to the complications that come to play for cardiology billing. Successful navigation of the payers' policies and procedures for paying surgery claims requires specialized knowledge that comes from experience with billing for cardiologists.

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.

One of the major drawbacks of hiring a company that does not specialize in cardiology billing is their lack of familiarity with the procedures and the terminologies used. Even if the medical billing company serves one or two cardiologists, they will lack the depth and breadth of expertise required for successful cardiovascular billing. Moreover if the hired company does not specialize in billing for cardiologists, then they will not have the expertise to effectively appeal denied claims or answer questions raised by the insurance companies.

A company that does not encompass a wide range of cardiovascular billing experience will find it difficult to track underpayments since multiple procedure rules and cardiovascular procedures have significantly more complicated contractual adjustments than a typical family doctor or internist's claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in billing for cardiovascular practices.

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.

The bottom-line: It is not worth the risk for a cardiologist to use a billing company that is not as focused as he or she is on cardiology. Just as a patient should not go to a family doctor for complex cardiovascular diagnostics, a cardiologist should not go to a generalist billing company for medical billing.

Copyright 2008 by Carl Mays II - 16890

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