Cardiology Billing Services for Cardiology Practices
A cardiology visit rarely stays a simple visit. The same appointment can include an office E/M, an ECG and an echo, and each one is paid under its own rules. Some tests are billed whole. Others are split into a technical piece and a professional read, depending on who owns the equipment and where the patient was tested. Add authorizations for nuclear and CT studies and it gets easy to see why tests go unpaid, or get paid wrong. Our cardiology billing services are built around that mix, so every visit and every test is billed the way the payer expects.
Where cardiology claims go wrong
Six places cardiology groups lose money.
Global, TC or 26?
Many cardiac tests can be billed as one global charge, or split into a technical component (TC) and a professional interpretation (modifier 26). The right choice depends on who owns the equipment and where the test happens. Pick the wrong one and you risk a denial, or an overpayment you will have to give back.
A visit and a test on the same day
When an office visit lands on the same day as a test or procedure, the note has to support a separate, significant E/M. Modifier 25 goes on where it is required. Payers look hard at this pairing.
ECG, echo, stress tests and monitors
Each has its own coding rules, coverage criteria and diagnosis requirements. Stress tests with imaging, and long-term monitors with set-up, hook-up and interpretation, are billed in separate pieces. It is easy to lose one of them.
Approvals for nuclear, CT and MRI
Many payers want prior authorization for nuclear cardiology, cardiac CT and MRI, and some ask for it on echo too. A missing or expired approval is one of the most common reasons these claims deny.
Cath lab and device procedures
Catheterizations, device implants and similar procedures come with global periods, bundling edits and modifiers for bilateral, repeat and multiple procedures. Facility and office settings pay differently, too.
Device checks, remote monitoring and rehab
Device interrogation, remote monitoring and cardiac rehab each come with separate coding rules, frequency caps and documentation demands. Many payers review them for medical necessity.
What we take off your plate in cardiology
Hand us the whole revenue cycle, or only the pieces that keep stalling.
Benefits checked before the test
Before the patient arrives, our eligibility verification work confirms coverage and testing benefits, and flags plans that want a referral first.
Approvals for echo, nuclear and CT
We learn which payers need approval, send the request with the clinical details, and chase it through prior authorization until it is approved. The expiry date goes on our calendar too.
Visit and test coding
Before anything is billed, the medical coding team reads the record against E/M levels, test codes, TC and 26 splits and modifiers.
Charges that match the schedule
Visits, tests and procedures are keyed in through charge entry and compared with the day's schedule, so an ECG or echo does not slip by unbilled.
Claims that reach the right payer
We check place of service and diagnosis links before claim submission. Both change how testing gets paid.
Posting line by line
Payments are posted by service line. If a test pays less than it should, it gets flagged instead of hiding inside a total.
Denials worked and explained
Our A/R and denial team works medical necessity, authorization, modifier and bundling denials, then tells your front end what caused them.
Enrollment for new cardiologists
When a cardiologist or mid-level provider joins the group, we handle credentialing with the payers you bill.
Reports a cardiologist will read
Every month you get A/R by payer, denials by reason, and test volume next to what was billed.
Your cardiology systems
We work in your EHR, your cardiology information system and your billing software, so your staff keeps the tools it already knows.
Getting started with cardiology billing
What happens between hello and the first full month.
Start with your test mix
We look at which tests you run in-house, who owns the equipment, and which payers you bill most.
Write down the payer rules
Authorization lists, TC and 26 handling and referral rules get documented for each plan.
Set up secure access
We connect securely to your systems and give the front desk a short pre-test checklist.
Work the claims
Verification, coding review, claims, posting and follow-up start running on a schedule we agree on together.
Read the numbers with you
Denials, A/R and test-level trends are reviewed with your team on a regular basis.
Keep reading
Authorizations
Echo, nuclear and CT often need approval before the test happens. Here is how our prior authorization services work.
When tests are denied
See how our A/R and denial management team follows up on testing denials.
Cardiac imaging
Cardiac imaging overlaps with imaging billing. See our radiology billing services.
See where your cardiology claims are stuck
Testing denials, slow authorizations and TC and 26 splits are the usual suspects. If you suspect one of them, give us a few details about your practice. A free billing audit is the easiest way in.
Get a Free Billing AuditCall (321) 788-3655Frequently Asked Questions
What cardiology groups ask us first.
1. Do you bill the technical and professional parts of cardiac tests separately?
Yes, when that is the right way to bill. We use the global service, or the technical and professional pieces with the right modifiers. It comes down to who owns the equipment and where the test is done.
2. Can you handle prior authorization for echo, nuclear and cardiac CT?
Yes. We check each payer's rule first. If approval is needed, we file it, follow up until it comes through, and note when it runs out.
3. What happens when a visit and a test fall on the same day?
We read the note to see whether it supports a separate E/M. If it does, modifier 25 goes on where the payer requires it, and we follow that payer's edits.
4. Do you bill device checks and remote monitoring?
Yes. We follow each payer's coding, documentation and frequency rules for device interrogation and remote monitoring.
5. Will we have to change our cardiology software?
No. We work inside your current EHR and billing system with secure access.
Related specialties
Cardiology groups often share patients and imaging with these.
Radiology Billing
Where cardiac CT and MRI billing overlaps with imaging.
Multi-Specialty Billing
For groups that run cardiology next to other departments.
Orthopedics Billing
A different procedure world, with global periods of its own.