As practitioners dedicated to patient care, it’s important to ensure the financial aspects of your practice are well-managed.
In specialties such as cardiology, dermatology, and pediatrics, medical billing presents its own set of challenges, with specific requirements for each service rendered.
Industry statistics indicate that a notable percentage of healthcare revenue is lost due to billing errors and claim denials. This guide aims to clarify the medical billing process for these specialties, providing a straightforward approach to enhance your billing efficiency and financial stability.
It is created to help you navigate the complexities of medical billing, reduce errors, and maintain a healthy revenue stream for your practice.
So, without any further delay, let’s get started.
Cardiology
Billing for cardiology treatment is as complex as the conditions you treat. With procedures that can range from a simple EKG to a full-blown angioplasty, each step, each test, each intervention must be coded with precision.
A single misstep here, and you’re looking at a denial rate that can hit the 15% mark – a direct hit to your revenue stream.
But it’s not just about avoiding missteps; it’s about setting up your billing process to the rhythm of the latest coding updates. Stay in sync, and you’ll keep the lifeblood of your practice flowing.
Common Cardiology CPT Codes:
92950 – Cardio-pulmonary resuscitation (CPR):
Description: This code is used for reporting cardiopulmonary resuscitation services provided in the hospital setting.
93306 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed; complete
Description: This code is used for reporting a comprehensive transthoracic echocardiogram, including real-time 2D imaging and M-mode recording.
93503 – Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes
Description: This code is used for reporting the insertion and placement of a flow-directed catheter, such as a Swan-Ganz catheter, for hemodynamic monitoring.
93610 – Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads, including defibrillation threshold evaluation with induction of arrhythmia
Description: This code is used for reporting the electrophysiologic evaluation of single or dual-chamber pacing cardioverter-defibrillator leads, including defibrillation threshold evaluation.
Dermatology
Dermatology billing might seem straightforward, but it’s layered with complexity.
Consider this: up to 25% of potential income can vanish due to coding errors, particularly when distinguishing between medical necessity and cosmetic choice. And with the rise of tele dermatology services, which saw a 50% increase during the pandemic, there’s a whole new dimension to billing that requires your attention.
The challenge is to maintain a balance between medical and cosmetic billing – a balance that, if lost, can lead to significant revenue leakage.
Common Dermatology CPT Codes:
11100 – Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion
Description: This code is used for reporting the biopsy of a single skin lesion, including simple closure if performed.
17000 – Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion
Description: This code is used for reporting the destruction of premalignant lesions, such as actinic keratoses, for the first lesion.
17003 – Each additional lesion
Description: This code is used for reporting the destruction of each additional premalignant lesion beyond the first lesion.
96910 – Photochemotherapy; tar and ultraviolet B (Goeckerman treatment)
Description: This code is used for reporting photochemotherapy using tar and ultraviolet B for conditions such as psoriasis (Goeckerman treatment).
Pediatrics
Pediatric billing is like keeping up with kids – it’s always on the move.
With a 20% chance of missing out on reimbursements for vaccinations due to coding errors, the stakes are high. And it’s not just about getting the codes right; it’s about adapting to the ever-changing immunization schedules and preventive service codes.
The goal? To ensure that your billing practices grow and adapt as quickly as the little ones you’re treating.
Common Pediatrics CPT Codes:
99381 – Initial comprehensive preventive medicine evaluation and management of an infant (age 28 days or younger)
Description: This code is used for reporting the initial comprehensive preventive medicine evaluation and management of an infant.
99392 – Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (1 through 4 years)
Description: This code is used for reporting periodic comprehensive preventive medicine reevaluation and management for a child in early childhood.
90471 – Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
Description: This code is used for reporting the administration of one vaccine, whether it is a single vaccine or a combination vaccine.
96127 – Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument
Description: This code is used for reporting a brief emotional/behavioral assessment using a standardized instrument, with scoring and documentation.
Overview
Take a step back and consider the medical billing overview of your practice. Are you seeing a healthy stream of revenue, or are there blockages in your cash flow?
With the industry losing approximately $125 billion due to inefficient billing practices, and providers spending an average of 3.5 hours per week on billing-related tasks, it’s clear that there’s room for improvement.
Accounts Receivable (A/R) and denial management are critical aspects of revenue cycle management for medical practices, including those specializing in Cardiology, Dermatology, and Pediatrics. Here’s a general overview of key considerations for each specialty:
A/R and Denial Management for Cardiology, Dermatology and Pediatrics Practices
Cardiology
Ensure accurate and timely submission of claims to payers.
Verify that all required documentation is attached to the claims, including diagnostic reports and supporting documents for procedures.
Coding Accuracy:
- Regularly audit and review coding practices to minimize errors.
- Keep coders updated on the latest coding guidelines and changes.
Denial Analysis:
- Analyze denial patterns to identify common issues.
- Implement corrective actions based on denial trends.
Payer Contract Management:
- Regularly review and renegotiate payer contracts to ensure favorable reimbursement rates.
- Understand and follow the specific billing requirements of each payer.
Patient Education:
- Clearly communicate financial policies to patients, including copayments, deductibles, and any out-of-pocket expenses.
- Provide assistance with insurance-related inquiries.
Dermatology:
Accurate Documentation:
- Ensure thorough documentation of dermatological procedures and diagnoses.
- Use specific codes for different types of skin lesions, biopsies, and procedures.
Prior Authorization:
- Obtain prior authorizations for procedures and treatments, especially for cosmetic or elective procedures.
- Verify that prior authorization requirements are met before rendering services.
Coding Expertise:
- Maintain up-to-date knowledge of dermatology-specific CPT and ICD-10 codes.
- Train staff on accurate coding practices and documentation.
Appeals Process:
- Establish a streamlined process for appealing denied claims.
- Keep track of denied claims and prioritize appeals based on potential reimbursement impact.
Patient Billing Transparency:
- Clearly communicate to patients the cost of procedures, especially for cosmetic services.
- Offer flexible payment plans and financial counseling when needed.
Pediatrics:
Well-Child Visit Coding:
- Ensure accurate coding for well-child visits and preventive services.
- Promote regular well-child visits to improve preventive care.
Vaccine Management:
- Monitor vaccine inventory and administration to maximize reimbursement.
- Stay informed about vaccine coding and billing guidelines.
Pediatric-specific Codes:
- Familiarize staff with pediatric-specific codes for developmental screenings and assessments.
- Use appropriate codes for common pediatric conditions.
Timely Follow-up:
- Implement processes for prompt follow-up on denied claims.
- Address coding errors and resubmit corrected claims promptly.
Insurance Verification:
- Verify insurance coverage for pediatric patients before appointments.
- Identify any insurance changes to prevent claim denials.
General Tips for All Specialties
Technology Utilization:
- Implement billing and practice management software to streamline processes.
- Use electronic claim submission to reduce errors and speed up reimbursement.
Regular Training:
- Conduct regular training sessions for staff on billing regulations, coding updates, and denial management processes.
Performance Metrics:
- Monitor key performance indicators related to A/R aging, denial rates, and cash flow.
- Use data analytics to identify areas for improvement.
Provider and Staff Collaboration:
- Foster collaboration between providers, billing staff, and administrative personnel to address billing issues effectively.
The Future of Medical Billing
Looking ahead, the integration of AI in medical billing promises to cut the time spent on billing tasks by up to 50%. This advancement is not just about keeping up; it’s about staying ahead, ensuring that your practice can focus on what it does best – providing top-notch care.
GreenSense Billing: Multi-Specialty Medical Billing Experts
When it comes to multi-specialty medical billing, GreenSense Billing stands out as a beacon of expertise. With a deep understanding of the unique challenges faced by different medical specialties, GreenSense Billing offers tailored solutions that address the specific needs of your practice.
Whether you’re dealing with the intricacies of cardiology codes or the delicate balance of dermatology procedures, our team is equipped with the knowledge and tools to ensure your billing is handled with precision and care.
FAQs About GreenSense Billing
Q: Does GreenSense specialize in cardiology billing?
A: Absolutely, we’re experts in multi-specialty medical billing
Q: How can GreenSense improve my billing efficiency?
A: Our medical billing services streamline your billing process, saving time and money.
Q: Will GreenSense Billing keep my AR days under control?
A: We aim to significantly lower your accounts receivable days.
Q: How does GreenSense stay current with coding changes?
A: We continuously update our practices with the latest coding regulations.
Q: Is GreenSense Billing leveraging AI technology?
A: We’re at the forefront, incorporating AI to enhance billing processes.
With GreenSense Billing, you’re not just hiring a billing service; you’re partnering with specialists who are as committed to the financial health of your practice as you are to the health of your patients.
Let us take the burden of billing off your shoulders, so you can focus on what you do best – caring for your patients.
Wrapping It Up
So, there you have it. From the 15% denial rate in cardiology to the 25% revenue loss in dermatology, and the 20% unreimbursed vaccines in pediatrics, it’s evident that specialized medical billing is fraught with challenges.
But with this medical billing overview and a keen eye on the latest in RCM, you can navigate these challenges.
Keep this medical billing guide as your reference, stay informed, and consider whether managed billing services could be the lifeline your practice needs. With the right strategies in place, you can ensure that your practice’s financial health is just as strong as the care you provide.
And remember, in the world of medical billing, every claim is a patient, and every correct code is a testament to the care you’ve provided. Keep pushing forward, and let’s keep that financial heartbeat healthy!
