There is a lot of low-hanging fruit in most cardiology and electrophysiology practices. Following are the top ten areas in which you can increase the profitability of your practice.

#10: Be Aware of Your Post-Op Billing Opportunities
Reimbursement for pacemaker and defibrillator surgeries includes routine surgical recovery services provided in the 90-day post-operative period. This is most commonly limited to discharge following the procedure and an incision site check shortly after discharge.

However, Medicare policy specifies that “Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery” and “Visits unrelated to the diagnosis for which the surgical procedure is performed” are separately reimbursable. Medicare requires that we attach the 24 modifier to these evaluation and management services to confirm that they are not routine post-operative care.

Diagnostic tests, like pacemaker or defibrillator checks, performed during the 90-day post-operative period should also be separately reported. Many physicians wait for 90 days before bringing patients into the office to evaluate and optimize device settings; this wait period is not necessary. An alternative approach is to perform this initial post operative device check at the same time as the incision site check. While no reimbursement will be provided for the incision site check, the practice will be compensated for the device check.

#9: Use Mid-Level Providers Effectively
Medicare’s recent elimination of reimbursement for consultative services removes the most problematic restriction associated with mid-level billing. Now, mid-level providers can render and dictate all consultative, admission, follow-up, and discharge notes for their supervising physician in the hospital setting. As long as the physician personally evaluates the patient face-to-face on the same day and documents his/her service, the shared visit can be reported by the physician and paid at 100% of the physician fee schedule.

Mid-level providers can provide follow-up visits in the office setting and the supervising physician can personally bill for these services as long as Medicare’s “incident-to” rules are met. Since Medicare has increased reimbursement for follow-up office visits, we have an incentive to see patients in follow up more frequently. Having mid-level providers see patients back at six-, eight, or ten-month intervals generates more revenue than personally seeing the patient at annual intervals.

Mid-level providers can also manage your device clinics. This will generate more revenue than if a device company representative runs the clinic, because Medicare has specified that the professional component modifier (26) must be appended to any device clinic services provided by a device company representative; this reduces reimbursement by $20-$31 per device check.