Efficient and effective cardiology revenue cycle management (RCM) is vital in ensuring the financial stability and operational effectiveness of private cardiology practices. The complexities involved in cardiology RCM introduce distinct challenges, such as dealing with administrative churn across patient billing, insurance claims, and prior authorizations, adhering to regulatory compliance, and ensuring reimbursement is completed correctly. These hurdles can overwhelm internal teams, resulting in inefficiencies and possible revenue losses. However, by partnering with a specialized cardiology billing services expert, practices can enhance their revenue cycle without losing sight of patient care.
The requirements of cardiology RCM in modern healthcare often overwhelm internal teams.
However, finding a specialized partner can help you improve cardiology RCM and optimize internal processes so you can focus on patient care.
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Top Cardiology RCM Roadblocks
Cardiology RCM has a lot of complicated moving parts that create a tangled web of roadblocks for specialty practices:
- Prior Authorizations: Prior authorizations tend to put significant administrative strain on practices. Getting these required approvals is complicated, time-consuming, and regularly changing. However, issues across the board can lead to denied or delayed payments, which can significantly impact cash flows.
- Reimbursement: Like prior authorization, accurate and timely reimbursement is central to cardiology RCM. Unfortunately, it has become increasingly complicated due to constantly changing payer policies, coding requirements, and fee schedules. Any mistakes can lead to denials and underpayments, again impacting practice revenue.
- Payor and Regulator Requirements: As mentioned above, navigating the complex maze of cardiology RCM requirements is challenging, even for the most well-equipped practices. The average practice won’t have the personnel or systems readily available to handle the evolving requirements. Even a simple accident caused by an outdated number can cause delayed payments or fines.
Of course, these challenges all come together across practice operations. Each involves a lot of time – which can take already scarce resources away from another. On top of that, rules and regulations across legislation and insurance are constantly changing. It requires highly specialized tools and expertise to avoid denials and ensure proper reimbursement.
According to Equifax, poor billing practices result in doctors in the US losing approximately $125 billion per year, or an average of about $5 million per provider.
Managing In-House is Easier Said Than Done
Cardiology RCM requires dedicated systems and highly-trained staff to effectively manage all the challenges in modern healthcare. Unfortunately, finding, hiring, training, and retaining the staff needed to do this effectively requires significant and ongoing financial investment. These teams also need modern tools and software to do their jobs, which is an additional cost. Of course, you can’t forget the hidden costs of strained staff, leading to errors, inefficiencies, and, ultimately, lost revenue.
The industry standard is typically one full-time biller for every 10,000 claims processed annually, resulting in an average of 2.7 billing employees per physician.
You Need an Expert Cardiology Billing Partner
Cardiology RCM starts before patients ever step foot into your practice. It begins as soon as an appointment is scheduled, reviewing insurance, obtaining necessary prior authorizations, and ensuring that documentation processes are ready.
We recommend finding an expert cardiology billing services partner who can leverage their team of experts to work with you to enhance your practice’s RCM. The right partner will provide you with specialty-specific expertise and insights and help you reduce administrative burdens so you can focus on your patients.
The right cardiology RCM partner will do more than just billing. They’ll work with you to optimize all operational processes within your practice. They’ll invest in the latest technology, train their staff on the latest policies, and know exactly what it takes to support your private practice.
Not all cardiology billing service providers are the same. Be sure to look for one with specialty-specific expertise to support your practice.
TRIARQ Health: Cardiology RCM Experts
At TRIARQ Health, we take a unique approach to RCM, aligning strategy, technology, and operations to ensure everything in your practice runs smoothly. We collaborate with your team to understand where your practice is now and where you want to be in the future to develop a custom strategy. We offer:
- Comprehensive dashboards and reporting with real-time data, claims, tracking, and more.
- Non-clinical practice administration to alleviate some of the procedural headaches you’re experiencing.
- Actionable insights and recommendations for ongoing improvement through automation and streamlined workflows to improve revenue.
Our strategic approach ensures that your RCM processes are efficient and effective for correct and timely payment and that you’re regularly making operational improvements to strengthen your practice’s finances.