How Everest Helped One of the Largest Cardiologist Groups Overcome Their Critical Coding Backlog

Mar 24

In the ever-evolving world of medical billing and revenue cycle management (RCM), managing critical coding backlogs is a challenge faced by many healthcare providers. For large healthcare groups, particularly specialty practices like cardiology, these backlogs can be a significant roadblock to efficient billing, timely reimbursements, and ultimately, a practice’s financial health.

At Everest, we specialize in addressing such challenges. One prime example of our success is our work with one of the largest cardiologist groups in Florida. This group faced an overwhelming backlog in medical coding, which led to delayed claims, denied payments, and a strain on their overall RCM process. By partnering with Everest, they were able to clean their critical coding backlog and get their revenue cycle back on track.

The Challenge:

The cardiologist group was facing a series of challenges in their medical coding process:
Coding backlogs that created delays in submitting claims.
Incorrect coding leading to denied claims and payment delays.
The sheer volume of coding work was overwhelming their internal team, resulting in missed opportunities for revenue.

In a specialty like cardiology, where billing for highly complex procedures and tests is the norm, the backlog was becoming a bottleneck in the practice’s revenue cycle. Every delayed or denied claim meant more lost revenue and a longer wait for payment, which put a strain on the practice's cash flow and overall financial stability.

Everest’s Solution:

Upon partnering with the cardiologist group, Everest’s certified coders quickly went to work to clean the critical backlog and set up efficient processes for ongoing billing. Here’s how we approached the challenge:

Assessment & Backlog Review:

Our team of certified coders thoroughly assessed the coding backlog by reviewing each case and identifying errors or missed claims.

Error Correction & Re-submission:

We corrected any coding mistakes, ensuring that claims were accurate and in compliance with all relevant regulations.

Claims were re-submitted promptly to payers, reducing the chance of future denials.

Real-Time Collaboration:

As part of our hybrid model, we leveraged cloud-based solutions to collaborate with the practice’s team in real-time, ensuring quick resolution of issues and fast communication.

Ongoing Support:

Once the backlog was cleared, our team put processes in place for more efficient coding and timely submissions, preventing future bottlenecks.

The Importance of Accurate Coding:

Accurate medical coding is the foundation of the entire RCM process. Without correct coding, the rest of the job becomes much harder:

Incorrect coding leads to denied claims and delayed payments, which can strain a practice’s financial resources.
When coding is done accurately, the rest of the RCM process—submission, follow-up, reimbursement, and appeals—becomes easier and more efficient.

At Everest, we understand that getting the coding right is the first step toward a smooth, efficient revenue cycle. Once the coding is handled correctly, the rest of the RCM processes fall into place, improving cash flow, reducing denials, and speeding up reimbursement.

A Certified Pool of Coders for Diverse Specialties:

At Everest, we don't just have expertise in cardiology coding. Our certified pool of coders is equipped to assist practices across various specialties, including: