How does EZ Settle Solutions reduce denied claims for cardiology revenue cycle management?

Struggling with Cardiology Claim Denials? Here’s How to Turn It Around.

Claim denials are more than just a temporary setback-they are a waste of time, money, and resources. Your team has probably spent weeks preparing and filing a claim by the time it is rejected. Additionally, there will be a longer wait time for refunds. Denials of cardiology billing are not an exception. Cardiologists now have an even harder time navigating this environment because insurance companies are enforcing stricter eligibility requirements.  

But what if there’s a proven way to minimize such setbacks and ensure smoother reimbursements?

At EZ Settle Solutions, we specialize in reducing denied claims through expert cardiology revenue cycle management (RCM), helping healthcare providers secure maximum reimbursements while delivering uninterrupted patient care.

What is the current denial rate for healthcare claims?

According to surveys, 38% of respondents reported that at least 10% of claims are denied, with some organizations experiencing denial rates exceeding 15%. These denials lead to significant rework and lost revenue that healthcare providers depend on.

In 2009, claims processing contributed to around $210 billion in wasted healthcare spending in the US. By 2019, this figure had risen to $265 billion. 

Reports, including Experian Health’s State of Claims series, show a steady increase in denial rates over the years.

Currently, 73% of healthcare providers believe claim denials are rising, and 67% feel it takes longer to get paid. Providers are increasingly concerned about who will pay their claims and when they will receive their reimbursements.

Understanding Cardiology Billing: A Complex Process

Cardiology billing is one of the most intricate aspects of medical billing and coding. It involves handling various procedures ranging from diagnostic tests like echocardiograms to complex surgical interventions such as angioplasties and stent placements.

The process includes:

1. Accurate documentation of services provided.
2. Precise coding with CPT and ICD-10 codes specific to cardiology procedures and diagnoses.
3. Timely submission of claims adhering to payer policies.

Cardiology billing is challenging because:

• Codes frequently change, and keeping up with updates requires vigilance.
• Cardiology services often involve multiple procedures, necessitating detailed and error-free documentation.
• Misinterpretation of payer guidelines can result in claim denials.

This is where EZ Settle Solutions steps in with proven strategies to optimize billing accuracy and minimize denials.

How EZ Settle Solutions Reduces Denied Claims in Cardiology Billing

Ensuring Accurate Coding Practices

Medical coding for cardiology requires attention to detail, as even minor errors can result in claim denials. Our certified coders stay updated with the latest coding changes, ensuring that every procedure and diagnosis is assigned the correct CPT, ICD-10, or HCPCS code.

Key Benefits:

• Reduction in coding errors.
• Compliance with payer-specific requirements.
• Faster claim approvals.

Comprehensive Documentation Support

Incomplete or unclear documentation is a primary reason for denied claims. Our team works closely with healthcare providers to ensure that patient records comprehensively reflect the services rendered.

Our Approach:

• Training staff on proper documentation techniques.
• Conducting audits to identify gaps in medical records.
• Providing actionable feedback for improvement.

Why It Matters:
When payer reviewers can easily match the claim with the supporting documentation, the likelihood of denials decreases significantly.

Pre-authorization and Eligibility Verification

Cardiology services often require pre-authorizations, especially for high-cost procedures like cardiac catheterizations or pacemaker implantations. EZ Settle Solutions ensures that pre-authorizations are secured before services are rendered.

Steps We Take:

• Verifying patient eligibility and coverage.
• Communicating with insurers to obtain necessary approvals.
• Monitoring authorization timelines to avoid delays.

This proactive approach minimizes claim rejections due to missing pre-approvals or coverage issues.

Proactive Denial Management

Even with the best practices, some claims may still face denials. Our denial management experts quickly identify the root causes, whether it’s incorrect coding, missing modifiers, or payer-specific nuances.

How We Address Denials:

• Reviewing denied claims for actionable insights.
• Correcting errors and resubmitting claims promptly.
• Keeping providers informed of recurring issues to prevent future denials.

Result: 

Our efforts ensure that cardiology practices recover revenue that might otherwise have been lost.

Staying Updated with Payer Policies

Payer policies for cardiology billing can be complex and vary across insurers. Our team constantly monitors changes in reimbursement guidelines to ensure compliance.

What We Do:

• Update billing workflows based on the latest insurer rules.
• Cross-check claims for compliance before submission.
• Communicate with payers to clarify ambiguities.

This vigilance significantly reduces claim rejections due to non-compliance.

Leveraging Advanced Technology for Efficiency

EZ Settle Solutions utilizes advanced billing software and analytics to enhance the cardiology RCM process.

Our Tools Include:

• Automated claim scrubbing to catch errors before submission.
• Data analytics for identifying trends in denied claims.
• Reporting dashboards for real-time monitoring of claim statuses.

These technologies streamline the billing process, improve accuracy, and boost practice profitability.

Customized Solutions for Cardiology Practices

We understand that every cardiology practice is unique, which is why we offer tailored solutions to address specific challenges.

Our Customization Includes:

• Personalized reporting to track revenue performance.
• Flexible billing models to suit practice needs.
• Dedicated account managers for continuous support.

This personalized approach ensures that practices experience measurable improvements in their revenue cycle.

Why Choose EZ Settle Solutions?

• Expertise in Cardiology Billing: Our team has in-depth knowledge of cardiology-specific procedures, codes, and payer requirements.
• Focus on Compliance: We adhere to all regulatory guidelines, including HIPAA and payer policies.
• End-to-End Support: From eligibility checks to denial resolutions, we handle the entire revenue cycle, so providers can focus on patient care.

Benefits of Partnering with EZ Settle Solutions

By choosing us, cardiology practices can:

• Reduce denied claims by up to 98%.
• Accelerate cash flow and reduce A/R days.
• Minimize the administrative burden on in-house staff.
• Ensure compliance with ever-changing coding and billing rules.

FAQs

• What is cardiology billing, and why is it challenging?

Cardiology billing involves coding and submitting claims for complex procedures like angioplasties and echocardiograms. It’s challenging due to frequent code changes, detailed documentation requirements, and strict payer guidelines

•  How does EZ Settle Solutions reduce claim denials for cardiology practices?

We ensure accurate coding, comprehensive documentation, pre-authorization, and real-time compliance with payer policies while leveraging advanced technology to streamline the revenue cycle.

• Why do claims get denied in cardiology billing?

Common reasons include coding errors, missing modifiers, incomplete documentation, and failure to meet pre-authorization or payer-specific requirements.

• What benefits can cardiology practices gain by partnering with EZ Settle Solutions?

Practices can reduce denials by up to 98%, improve cash flow, ensure compliance, and minimize administrative burdens, enabling them to focus on patient care.

• How does technology help in reducing denied claims?

We use advanced tools like automated claim scrubbing, data analytics, and real-time dashboards to catch errors, monitor trends, and optimize the billing process.

Take Control of Your Revenue Cycle Today!

Cardiology billing doesn’t have to be a roadblock to your practice’s success. With EZ Settle Solutions as your partner, you can eliminate claim denials, maximize reimbursements, and focus on what matters most-delivering exceptional care for your patients.