Billing and Reimbursement Essentials for CV Professionals-Professional Services Billing & Reimbursement Fundamentals

Video Transcription

Video Summary

This comprehensive webinar by Linda Gates-Striebe from MedAxium provides an essential overview of billing fundamentals for cardiovascular professionals, focusing on revenue cycle management (RCM). It covers the entire revenue cycle process—from patient registration, eligibility verification, and obtaining authorizations to coding services, claim submission, and handling denials.<br /><br />Key billing components discussed include CPT codes (procedure codes), ICD-10 codes (diagnosis codes), and modifiers. CPT codes describe what was done, while ICD-10 explains why, and modifiers add important additional information affecting billing and reimbursement. The session emphasizes accurate coding, proper linkage between diagnosis and procedure codes, and understanding payer requirements—crucial to avoiding claim denials and delays.<br /><br />The presentation details Medicare’s payment system, including relative value units (RVUs), geographic adjustments, and fee schedules, demonstrating how changes in CPT coding and bundling impact physician reimbursement. It also explains the use of global surgical packages, medically unlikely edits, and National Correct Coding Initiative (NCCI) edits to prevent improper billing.<br /><br />The ICD-10 coding system is thoroughly reviewed, stressing specificity, proper sequencing, and common denial triggers like “code first” rules. The importance of hierarchical condition categories (HCC) for risk adjustment and value-based care reimbursement is highlighted.<br /><br />Modifiers, such as 25 (significant and separate services), 59 (distinct procedural service), and 22 (increased procedural complexity), are explained as essential tools to communicate exceptions and ensure appropriate reimbursement.<br /><br />Throughout, the talk encourages clinician engagement in the revenue cycle, teamwork with coding/billing staff, and continual education to optimize billing accuracy, reduce denials, and maximize revenue collections. The session concludes by previewing future topics on claim denials and edits.

Keywords

Cardiovascular billing

Revenue cycle management

CPT codes

ICD-10 codes

Modifiers

Claim submission

Denial management

Medicare payment system

Relative value units

Global surgical packages

National Correct Coding Initiative

Hierarchical condition categories

Value-based care reimbursement