In the medical billing process, the auditing of clinical documentation is very important, it proves the accuracy and effectiveness of the process which helped the payer to distinguish between the appropriate and inappropriate billing practices. Like any other medical practitioner, the cardiologist also takes the assistance of the medical auditing team to review their medical documentation to avoid any errors that lead them towards billing issues. In this article, we will figure out some of the auditing issues faced by the Cardiologist and the best possible solutions to tackle those issues.
Not Only cardiologists but any other medical practices especially those who are working at a larger scale need a team of coders and auditors for a brief self-assessment of their documentation. New policies by the insurance companies and new regulations by the state agencies have raised more challenges for the auditing team. Besides this, the ineffectiveness in auditing is also a big challenge to deal with. All these factors are collectively responsible for the insufficient billing process.
There are multiple factors that are responsible for improper auditing, some of them are described below:
Lack of specificity, accuracy, and completeness in the coding is one of the most prominent auditing problems an auditor faces. Especially in cardiology assessment upcoding and under coding are very common. Improper coding leads to claim denials and various other complications like criminal charges for false claiming.
Improper documentation of patient medical history also raises the chances of auditing issues. Proper documentation is very important for effective auditing. Insufficient or inaccurate information about the insurance provider also affects the auditing process. An inexperienced billing team can further slow down the auditing process.
Solutions for Auditing Issues:
As we determined the auditing issues faced by the cardiologist, here are some remedies to resolve these auditing issues.
Determine your scope:
The first step to deal with the auditing issue is to determine the scope of your practice. You have to gauge the requirements of your staff and procedures used for billing operations, and also make a list of the insurance providers you are working with.
After that, make a crystal clear documentation of all the patient data and ensure the accuracy of coding. It has been seen that upcoding and under coding are very common in cardiology practices. This is due to the frequent changes in the coding activity so you must ensure that you have the best team of coders at your disposal.
Enter accurate information:
For effective medical billing, the complete and appropriate information of the patient is necessary. Before starting the treatment process, make sure that you gather all the essential information from the patient like his name, address, etc.
This information is necessary to claim the reimbursement. The use of an Electronic Health Record system can help you to ensure high-quality documentation and avoid the risk of wrong documentation which is particularly very common in cardiology.
Besides the demographic information, the most important step is to take the information of the patient insurance company, registration, and billing staff to ensure that all the essential information should be noted before the start of the treatment.
As most cardiac treatments are very expensive so the service provider may verify with the patient about the coverage of the services under his insurance agreement. Sometimes the patient may receive treatment that is not included in the insurance agreement.
It is the responsibility of the billing team to make sure that they review the insurance policy and tell the patient about the treatments and services which are part of the insurance agreement and which are excluded from the agreement.
These are the solutions of auditing issues faced by the Cardiologist.
You must randomly review some documents to make sure that there are no chances of errors like upcoding or under coding. By reviewing the documents from the provider and the payer you can simply figure out the false claim ratio and make a formal self-auditing plan.
FInd coding error:
In the cardiac billing process, the changes in the codes occur frequently due to the procedures which are applied to treat a cardiac patient like angioplasty, stent replacement, and ECG, So the chances of upcoding and under coding also arise. If not addressed properly then there are chances that the service providers may lose revenue.
Using combo-codes for different cardiology treatments is helpful, On the other hand in cardiology, treatment avoids coding for the symptoms if they are not part of the treatment process.
Your coding team also needs to check the modifiers regularly, as failure to add the proper modifier may result in delay and denial in the reimbursement. The coding guideline is an ever-changing trend so the coders must keep themselves up to date.
Having a team of coders who make sure the timely addition of modifiers is very essential. You can also outsource a team that is experts in dealing with coding and updating the modifiers on a regular basis.
Train your staff members:
Most of the auditing issues occurred due to the negligence of the staff member in the billing process results in coding errors and false documentation. To deal with this issue a proper training of the staff members is very essential or you can hire some experienced coders in your team who can handle your revenue cycle more appropriately.
Outsourcing the team of experts is the best way to deal with the auditing issues. The billing process is very complex in nature and the chances of errors are higher especially in cardiac treatment so it is best for them to outsource their billing team and focus on patient care.
The Mediators provides auditing services to those who work extensive hours and still have a low collection rate. Our dedicated team ensures you proper coding, fewer denial rates, and a regular follow-up on missed reimbursement. Call us at for further information.