Each specialty experiences unique challenges in the area of charge capture. Cardiologists often interpret the results of ECG, echo, and stress tests performed at hospitals. The cardiologist sits down in front of 30, 50, or 100 test results and quickly analyzes them, spending no more than a few minutes on each.
The reimbursement from insurance payers for each interpretation is quite small - for example, Medicare's 2013 fee schedule lists an average of $8 per ECG interpretation, of which Medicare pays 80 percent, or $6.40. The remaining $1.60 can theoretically be collected from the patient or from a secondary insurance carrier.
To complicate things further, the majority of these patients aren't even associated with the cardiology service at the hospital. They aren't, strictly speaking, cardiology patients - and if their tests come back normal, they may never be! A hospitalist, ER physician, or another specialist ordered many of these tests to be performed to rule out cardiac issues.
This puts the cardiologist in a pickle. Typically the physician's effort to capture all the necessary information for billing and get that information to the billing staff will significantly exceed $6.40 worth of time - especially when combined with the billing staff's time spent filling in any missing demographics, registering a new patient, checking the diagnosis and billing codes, and creating a claim.
Several cardiology groups that I've spoken with have told me that due to these challenges, they just didn't bill at all for interpreting the lower-reimbursement tests. Simply put, it wasn't worth it. They would spend more time and money trying to get paid than the reimbursement was worth, and they had bigger fish to fry. This seems like sound business sense, but they were left with a lingering feeling that money was being left on the table and that they weren't being paid for all of their work.
Depending on the capabilities of your charge capture software, it is possible to capture this reimbursement with no physician effort and minimal time required by billing staff to create each claim. Cardiology Consultants Medical Group in Los Angeles worked with pMD charge capture to create a proprietary feed directly from the cardiology system in which they were submitting their reports. This system could produce electronic data for each test result as the physician interpreted the test. It turned out that this report also contained the necessary information to create a billing claim. By working with CCMG and with the hospital, pMD automated the process from end to end.
In an era of declining reimbursements and increasing time pressure on physicians and their staff, any new source of revenue is very welcome, as is this kind of deep automation that eliminates paperwork from a practice.
The message for all providers, not just cardiologists, is clear: choose a software company for charge capture that supports your specialty-specific needs and that will work with you to find additional revenue. With declining reimbursements, every $6.40 counts!