All Medicaid claims, eligibility determinations, remittance advice, and authorization requests all flow through the MMIS provider portal.
Cardiology billing for Arkansas practices
Cardiology medical billing services in Arkansas
Billing built around how Arkansas pays. The Medicaid MMIS portal. Authorization review through AFMC. Arkansas Blue Cross and BlueCard claims. Medicare through Novitas under Jurisdiction H. Coding, claims, denials, and aging A/R all sit with one team.
In Arkansas Medicaid and MMIS every day
Coding made for cardiology
Denials chased. A/R worked.
AR
Arkansas Medicaid
MMIS portal and AFMC review
BC
Arkansas Blue Cross
Commercial and BlueCard
MC
Medicare
Jurisdiction H, run by Novitas
RCM
Full cycle
Intake to A/R
Arkansas billing expertise
Cardiology billing shaped by Arkansas payer rules
Cardiology throws off a lot of claims. One patient, one afternoon, and the charges pile up. An office visit. An ECG. An echo. Maybe a stress test and a device check on top. Each one carries its own code and its own paperwork. Run all of it through a workflow meant for primary care and things fall through.
Arkansas adds its own layer. Medicaid runs on the state MMIS platform. Anything on the restricted procedure list has to clear AFMC before the patient is scheduled. Arkansas Blue Cross and Blue Shield is the state's Blue plan. Out-of-state Blue members route through BlueCard, sorted by the prefix on their card. Medicare lands with Novitas Solutions. That is the Jurisdiction H contractor, and it also handles Texas, Oklahoma, Louisiana, Colorado, New Mexico, and Mississippi.
We handle the whole arc for cardiology groups here. The eligibility check before the visit. The coding. The authorizations. Submission, posting, denial work. And the last A/R call that clears a stubborn balance.
Arkansas payer environment
The Arkansas cardiology billing landscape
Where a claim goes, and what it needs first, depends on the coverage and the service.
The Arkansas Department of Human Services (ADHS) limits some services through the AFMC authorization review process. Prior authorizations for services in the Physician’s Procedure Manual are requested through AFMC and considered prior to the date of service.
Provider enrollment and revalidation, as well as NPI changes and updates, are processed in a timely manner. An outdated provider record can delay or deny a claim for service.
Arkansas Blue Cross and Blue Shield (BCBS) provides confirmation of plan benefits, network status, and rules for plan authorization. This is done for each individual patient plan.
For members who hold a BlueCard, the prefix on their out-of-state card indicates the member’s home-state plan. Claims for services are sent directly to the home state plan.
Medicare Jurisdiction H processes Parts A and B claims for Arkansas. Home Health services claims must be covered under Novitas’s coverage rules.
Common billing challenges
Where Arkansas cardiology claims stall
Most denials here trace back to a short list.
Each payer (Medicare, Medicaid, Blue Cross, Commercial plans, etc.) has their own coding, authorization, and filing requirements.
The absence of AFMC (or Plan) approval means that a claim can be denied. Documentation supporting the claim will not help.
Coding can get very tricky, especially when there are multiple services or tests performed during a single visit. Each line needs to be justified with the correct code, modifier, and diagnosis.
A cardiac work-up done at the hospital is a professional service and a facility service. If there are any discrepancies, or if the service is performed by a different physician, the claim will likely be denied.
When claims are not submitted in a timely manner, it increases the risk that the service will not be reimbursed.
Cath lab or EP studies often generate numerous codes. If the codes are missequenced, bundling edits or other edits are applied, the lines are removed.
Our services
What we handle for Arkansas cardiology practices
The stages connect. A problem at intake can get resolved before it becomes a denial.
Confirm benefits before the patient arrives. Check copays, deductibles, and network coverage.
Documentation is coded to CPT, HCPCS, and ICD-10-CM codes. Modifiers are checked against the documentation.
ensured that all services performed get billed.
Patient, payer, coding, modifier, authorization data are reviewed before the claim is sent.
Claims are submitted through the clearinghouse. Claims are fixed and resent the same day they are posted.
Payment is posted against the contracted rate. Underpayments are flagged.
Traced the cause of the denial. Corrected if able to, and/or submitted an appeal to the payer.
Reconciled claims by balancing the dollar and age of the balances. Contact all payers until the claim is closed.
Up-to-date enrollment with all payers.
Procedures
Cardiology procedures we bill
Specialty support
Cardiology specialties we bill for
Each subspecialty has its own coding demands.
General cardiology:
The visit for diagnosis, the test (usually an echo) and the preventive follow up (mostly volume) are office visits, which are coded 9920x.
Interventional cardiology:
In addition to the codes, modifiers and supply documentation in office cardiology, interventional cardiology requires coding for various supplies and stents.
Electrophysiology:
Implants, ICD checks, and cardiac ablations are all evaluated and billed (technically and professionally) separately, like office visits.
Structural heart:
Modifiers are tricky when 2 physicians perform different parts of a case.
Cardiac imaging:
Nuclear cardiac studies, Echo, CT and MRI of the heart. All of these rely on documentation of medical necessity for the ordering diagnosis to justify the claim.
Heart failure and preventive cardiology:
Remote monitoring and Chronic care management have their own coding and billing cycles, and may be billed independently of an office visit.
Our process
The journey a cardiology claim takes through our team
Ten steps. Each one handed off to the next, from start to finish.
01
Registration:
Demographics and other information captured upfront
02
Eligibility and benefits:
Research cardiology benefits and review the member’s insurance and network status.
03
Authorization review:
Review and verify if services are restricted or required by the plan. Flag for approval if necessary.
04
Charge capture and coding:
The documenting provider reviews service capture and codes assigned.
05
Claim scrubbing:
Run the data through payer edits.
06
Claim submission:
Send the claim to the payer through the clearinghouse.
07
Payment posting:
The claim is reconciled against the contracted rates and the EOB and ERA are posted.
08
Denial Management:
Research and appeal or correct denials where the record supports.
09
A/R Follow up:
Work unresolved claims to resolution.
10
Reporting:
Provide claims data to the practice.
Specialty expertise
Why cardiology needs more than general billing
One encounter can hold an E/M visit, a diagnostic test, and a device check at once. Three services. Three sets of rules.
National Correct Coding Initiative edits bundle some of those pairings on their own. A coder has to know which ones bill together and which need a modifier to come apart. Guess wrong, and the line gets denied or quietly reduced.
Our coders read the chart first. They bill second. What's documented has to match what Arkansas Medicaid, Arkansas Blue Cross, Medicare, and the commercial plans will actually pay. That match is where the money is won or lost.
Outsourced RCM
Why Arkansas cardiology practices hand off billing
Outsourcing takes payer calls and follow-ups from already stretched clinical teams.
Someone else sits in the queues for Medicaid, AFMC and Arkansas Blue Cross.
The work keeps going through vacations, resignations and hiring lapses.
A team working these portals spots a denial trend, for example, before a once-a-month biller would.
Services that require AFMC or plan approval are flagged before the appointment to avoid a denial.
Dedicated staff does real denial and A/R work as opposed to doing it in between front-desk work.
Staff can report on claim status, denial reasons and A/R aging on a scheduled basis..
Statewide support
Cardiology practices we support across Arkansas
The work is remote. It runs over secure connections to the practice's own EHR and clearinghouse. So a group in Little Rock and one in a small town two hours out get the same handling, and neither notices a difference.
FAQ
Arkansas cardiology billing FAQ
What does a cardiology billing service do for an Arkansas practice?
From start to finish, it touches all aspects of the revenue cycle. It manages eligibility and authorization, coding, submission, posting, denial management, and A/R management. It works with all payers, including the Arkansas Medicaid, Arkansas Blue Cross, Medicare, and commercial payers.
How does Arkansas Medicaid billing work for cardiologists?
The MMIS (Medicaid Management Information System) is the single point of entry for claims, eligibility, and authorization. The rules are in the Arkansas Medicaid Physician Provider Manual.
Where does AFMC fit in?
Before a restricted procedure can be performed, the Arkansas Foundation for Medical Care (AFMC) does prior authorization. AFMC also does reconsiderations for requests that get denied.
Which cardiology procedures require Arkansas Medicaid authorization?
These codes are in the Physician's Provider Manual. The list of procedures is reviewed for any planned case, since the list is subject to change.
How does Arkansas Blue Cross authorization affect a claim?
When the plan requires it, a missing or mismatched authorization number is one of the top reasons a cardiology claim bounces. So we confirm it up front.
How are BlueCard patients billed?
The claim goes to Arkansas Blue Cross using the member's ID prefix. BlueCard forwards it to the patient's home Blue plan for the benefit decision.
Who processes Medicare claims for Arkansas?
Novitas Solutions processes Medicare claims for the states under Jurisdiction H. The states covered are Arkansas, Texas, Oklahoma, Louisiana, Colorado, New Mexico, Mississippi and other surrounding states.
Can you work our denials and aging A/R?
Absolutely! We trace denials to causes, correct if supported by the records, and file an appeal. We track open balances by age until closed.
Do you handle credentialing and enrollment?
Yes. We handle credentialing and enrollment for Medicaid and Medicare as well as tracking revalidations, NPIs, and demographics updates and participation with the Arkansas Blue Cross and other insurance companies.
Arkansas cardiology RCM
Ready to tighten up your revenue cycle?
From Medicaid authorization and cardiology coding to Medicare Jurisdiction H claims and the oldest items on your A/R. This is billing built around how Arkansas practices get paid.