Cardiology medical billing services in Delaware
Revenue cycle support for Delaware's cardiologists, independent cardiovascular practices and hospital-affiliated practices. We navigate the payer mix that makes this state its own puzzle. DMAP, the three Medicaid MCOs, commercial plans, BlueCard routing and Novitas Medicare.
Revenue cycle support for Delaware's cardiologists, independent cardiovascular practices and hospital-affiliated practices.
Make the payer mix a process, not a guessing game
Running a cardiology practice takes your full clinical attention. Delaware billing wants attention too, and of a different kind. You're dealing with commercial carriers, Medicare administration, and the Delaware Medical Assistance Program, each pulling in its own direction.
Our Delaware cardiology billing runs the whole cycle, from the first eligibility check to the last denied claim worked to resolution. And it's built around what's actually different here, not a generic template dropped onto a Delaware address.
First question on every Medicaid claim: FFS or managed care?
Delaware Medicaid is two-pronged. Fee for service and managed care. The path of authorization, the path of submission, the network check, and who you call when a claim stalls are all dictated by the category the patient falls into. So let's get that sorted out before anything else moves.
DMAP fee-for-service
As the patient is bound to take services under DMAP FFS, the practice has to directly deal with the state system for eligibility , authorization and claims.
- DMAP FFS enrollment and eligibility checks
- State authorization steps
- Claim submission and status tracking
- Secure provider messaging through the state platform
Medicaid managed care
Enrolled in an MCO instead? Then the work follows that plan: its participation rules, its authorizations, its portal, its claims and remittance.
- Highmark Health Options
- AmeriHealth Caritas Delaware
- Delaware First Health
- Plan-specific authorization and routing
DMAP portal and payer enrollment work
Get the provider data right before the claim ever ships
The Delaware Medical Assistance Portal targets activities to providers within the state system. You will also be happy to hear that there are several tracks: managed care participation, Managed Care-Only Provider (MCOP) screening, and Ordering, Referring and Prescribing (ORP) registration. Each has its own standards, and each can quietly decline a claim if it is out of date.
Provider enrollment
Initial DMAP enrollment, status tracking, revalidations, taxonomy updates, location data, and both individual and group billing entities.
MCOP and ORP work
MCOP screening and enrollment for managed-care-only providers, plus the limited-capacity ORP enrollment for anyone who orders, refers, or prescribes.
Line up the authorization before the service, not after
What requires authorization depends on the payer, the plan, the method, the site of service and the policy in place. It stirs. Our duty is to have the answer narrowed down early and then connect that approval to the next claim.
Check benefits
See if authorization needed for scheduled cardiac service at all.
Pull documents
Collect the clinical records the payer’s reviewer will wish to examine.
Send and track
Send to the appropriate payer or review vendor and track the status.
Link to claim
Obtain the permission number and place it on the outgoing claim where it belongs.
Separate lanes for Delaware's main cardiology payers
Medicaid managed care, commercial, BlueCard, Medicare. The regulations are different, sometimes quite different. So we keep lanes separate, which ensures staff can quickly identify the proper workflow instead of guessing which rules applies
Highmark Health Options
Some sophisticated imaging and cardiology services require authorization via HealthHelp. These include procedures such as myocardial perfusion imaging and stress echocardiography
Highmark Blue Cross Blue Shield Delaware
The commercial side has its own provider manuals, precertification rules, and network requirements. They don't match the Highmark Health Options Medicaid process, so we don't treat them as if they do.
Novitas Solutions, Jurisdiction L
Jurisdiction L mandates that any claims that fall under the umbrella of Delaware Medicare must be submitted to Novitas. It supports coding, modifier review along with medical necessity checks and follow up.
Out-of-area Blue Cross Blue Shield patients
Delaware practices see plenty of patients carrying out-of-state Blue cards. The alpha prefix on the member ID tells us the Home plan, and the claim generally routes through the local Host plan, Highmark Delaware.
Where Delaware cardiology claims tend to get stuck
Cardiology billing that covers the whole revenue cycle
Front-end verification through payment posting and A/R. Each piece feeds the next, so nothing falls into a gap between steps.
Eligibility & Benefit Verification
A Delaware Claim Submission process will typically include checklining DMAP FFS Eligibility, MCO Identity, and Medicare Advantage or commercial coverage. The biller also needs to verify network and authorization coverage.
Coding in Cardiology
A Medical coder must be familiar with the use of CPT,HCPCS, & ICD 10 Codes. He should be adept at handling modifiers and Place of Service Codes
Capture and entry of charges
Capture services so that you don’t miss cardiac-related, billable work such as ECGs or rhythm strip interpretations.
Scrubbing claims
Review demographics, NPIs, Payer IDs, code combinations and authorizations prior to claim submission.
Electronic Submission of Claims
Claims are then submitted via EDI to payer systems that include DMAP FFS program, Medicaid MCO, Commercial or Medicare Advantage Plans.
Posting of payment
Posts patient payments and reconciles accounts, and recognizes possible underpayments.
Denial management
Any denied claim needs to be studied. A biller needs to evaluate whether the denial is caused by coding or medical necessity error or any other reason. They then need to make the correction and re-submit it.
Follow-up A/R
Track and process claims to payment .
Credentialing and enrollment
Assist with enrollments and participation for Novitas Medicare program, DMAP FFS, MCOs and commercial plans and revalidations.
Procedures and cardiology specialties we bill
The workflow bends around whatever cardiovascular services your practice documents.
Cardiology procedures and services
- Office cardiology E/M visits
- ECG/EKG interpretations
- Echocardiography, TTE and TEE
- Stress testing
- Nuclear cardiology and myocardial perfusion imaging
- Holter and event monitoring
- Electrophysiology services
- Pacemaker and ICD services
- Cardiac catheterization
- Structural heart procedures
- Preventive cardiology
- Cardiac rehabilitation
Cardiology specialties
- General cardiology
- Interventional cardiology
- Electrophysiology
- Non-invasive cardiology
- Structural heart
- Cardiac imaging
- Nuclear cardiology
- Heart failure specialists
- Pediatric cardiology
One connected process, from registration through reporting
The steps below keep payer identification, coding, claims, payments, denials, and A/R tied together. No stage runs off on its own.
Patient registration
Start the RCM Process by collecting accurate and up-to-date Demographics data from Patients.
Eligibility & Benefits Verification
The second step will be to determine whether the patient is in-network and fulfill the payer requirements.
Plan identification
Ascertain whether MCO, FFS or commercial prior to initiating claim work.
Review network and authorization
Confirm participation and any procedure specific authorization.
Capture and coding of charges
Translate the documentation into full and accurate charges.
Claim scrubbing
Check claim data, provider information, coding combinations and authorization information.
Electronic claim submission
Submit to the correct payer and channel
Payment posting and reconciliation
Post remittance activity and reconcile insurance and patient responsibility.
Denial management
Identify the reason for denial and take appropriate correction/appeal.
A/R follow-up
Track aging and pursue payer until the claim is resolved.
Revenue-cycle reporting
Keep an eye on claims, payments, denials and A/R. .
Lighten the admin load without losing sight of the money
Outsourcing takes the daily billing work off of your clinical staff and places it in a team whose only job is to do this. Coding, complex claims, denial follow up, aging A/R and the payer specific steps that eat the day of a front desk.
Specialized support
Cardiology coding, claims, payer workflows, and enrollment admin, handled by people who work them daily.
Revenue-cycle visibility
Track payments, denials, aging claims, and resolution across the full lifecycle.
Cardiology practices we support across Delaware
Cardiology Billing strives to provide the same services regardless of practice type or scope. We ensure that a practice in every city of Delaware receives the same kind of attention.
Delaware cardiology pre-claim checklist
A quick front-end review that catches the routing and data errors before they turn into denials.
Delaware cardiology billing questions
Short answers on DMAP, the MCOs, authorization, BlueCard, and Medicare. Check each against current payer rules before you rely on it.
Q1. What services does a cardiology billing company perform for a Delaware practice?
Q2. How does Delaware Medicaid billing work for cardiologists?
Q3. What is the difference between DMAP fee for service and Delaware’s managed care?
Q4. Are prior authorizations required for Highmark Health Options for cardiology services?
Q5. How should Delaware practices bill for BlueCard patients?
Q6. Can you assist with Delaware Medicaid Provider Enrollment?
Get a billing workflow built around your payer mix
Cardiology Medical Billing is not merely submitting claims to insurance companies. It is a step by step process where a biller needs to be on his heels to avoid any sort of errors.