Cardiology medical billing, from stress test to device check
Certified coders, prior authorization and denial follow-up for cardiology groups that bill imaging, procedures and device checks.
- Electrocardiogram
- Echocardiogram
- Stress testing
- Nuclear imaging
- Stents
- Device checks
What does a cardiology billing company do?
A cardiology billing company codes office visits, stress tests, echocardiograms, catheterization and device checks, and handles the professional and technical component split on each study. DrCareMSO coders verify prior authorization for cardiac imaging, bill device checks when each 30 or 90 day cycle closes, and work every denial back to its cause.
- Updated
Where cardiology claims lose money
Cardiology has more payer edits, more split billing and more recurring billing cycles than most specialties. These are the four places we see revenue leave a practice.
Advanced imaging is held up before it starts
Nuclear stress tests, cardiac CT and cardiac MRI often need approval before the scan. A missed or late request means a denied claim that cannot be fixed with a resubmission. We check the payer rule at scheduling and request the approval before the patient arrives.
Reading in one place, performing in another
When your group reads a study that a hospital or imaging center performed, you bill the professional component only. When you own the equipment and the technician, you may bill globally or the technical component. A wrong split is a denial or an overpayment.
Device checks that never get billed
Pacemaker and defibrillator checks, loop recorders and event monitors each run on their own cycle. Miss a 30-day or 90-day window and that revenue does not come back. We keep every device on a calendar and bill each cycle once it is complete.
Valid claims denied by bundling edits
Electrophysiology studies and ablations carry many services that payers bundle by default. Services that are truly distinct can be separated with the right proof, but overuse draws audits. We separate them only where the record supports it.
What we bill in every cardiology claim
Our coders work from the full cardiology service list, not a general one. Each family below has its own payer rules, and each rule is checked before a claim goes out.
Diagnostic testing
ECG and stress testing, billed globally or split by component.
Electrocardiogram: tracing, interpretation or both
Cardiovascular stress test: supervision, tracing, interpretation
Cardiac imaging
Echocardiography, with stress echo and Doppler add-ons.
Transthoracic, stress and Doppler echocardiography
Catheterization and interventions
Diagnostic cath and coronary interventions, billed per vessel.
Cardiac catheterization and related studies
Coronary angioplasty, stent and atherectomy
Electrophysiology
EP studies and ablation, where bundling edits are strictest.
Electrophysiologic studies, ablation and related services
Device and remote monitoring
Event monitors, device interrogation and remote checks on set cycles.
External cardiac event and patient-activated monitoring
Pacemaker, defibrillator and loop recorder checks, in person and remote
Who did what decides what you bill
Every testing and imaging study has a technical part and a professional part. Pick the study, then say who owns the equipment and who reads it, and the claim line changes.
A complete transthoracic echocardiogram with spectral and color flow Doppler.
Performed
Equipment, technician and the recording of the study.
You bill this
Interpreted
The physician reads the results and signs the report.
You bill this
Your claim line
Global claim
One claim line
Your group performed and read the study, so one claim line covers both parts and no component split is needed.
Based on AMA procedure descriptors and the CMS Medicare Physician Fee Schedule professional and technical component indicators. Facility based claims follow the facility's contract, and payers differ, so we confirm each plan's rule at charge entry.
Device and monitoring checks, billed when the cycle closes
Pacemaker, defibrillator and monitor checks run on cycles. Choose a cycle and move the count to see when a claim becomes billable.
Remote checks of pacemakers and defibrillators are reported once per cycle of up to 90 days, and the claim waits until the cycle closes.
45
of 90 days
Not yet
The 90 day cycle is still open. Keep reviewing transmissions and hold the claim.
Based on the AMA descriptors for cardiac device checks and remote physiologic monitoring, and the CMS remote monitoring rules. Payers differ on timing and documentation, and we confirm each plan's rule.
How we run cardiology RCM
A five-step cycle that starts before the patient is scheduled and keeps going until the claim is paid. Each step ends with something you can check.
- 1
Check coverage and payer rules
We verify eligibility and look up the payer's rule for the exact test or procedure being scheduled, including site-of-service limits and frequency caps.
What you get: A coverage note on the appointment before the visit.
- 2
Secure authorization before the scan
Our prior authorization team submits the request with the clinical notes the payer asks for, and follows it until a decision is returned.
What you get: An approval number on file, or a clear reason it was denied.
- 3
Code the charge, split included
A certified coder sets the procedure, links the diagnosis and sets the component split at charge entry, so the claim is right before it is built.
What you get: A clean charge with the correct split.
- 4
Submit, post and track
Claims go out electronically. Payments are posted against the expected amount, and anything underpaid is flagged the same week.
What you get: A weekly view of what is paid, pending and short-paid.
- 5
Work denials and fix the cause
Each denial is read, corrected or appealed, and then grouped by reason every month so the same error does not return.
What you get: A monthly denial report with the top causes and what changed.
Why cardiology practices choose DrCareMSO
You run the practice and the cases. We run the claims, and we answer for the result.
Certified coders for cardiology claims
Your claims are coded by people trained on your specialty, not a general pool.
Approvals before the case is scheduled
Coverage and authorization are checked up front, so surgery and procedures are not held up or denied later.
Every denial worked to payment
We correct, appeal and follow up on each denial, then fix the cause so it does not come back.
A monthly report in plain language
You see what was billed, what was paid and why anything was denied, with no digging through portals.
One cardiology group, two leaks, fixed
Scenario: a multi-provider cardiology group losing revenue to stress echo and device-check denials. This is how the work changed.
Before: Stress echo claims were denied when the component split did not match who read the study
After: The split is set at charge entry from who performed and who read each study
Before: Device checks were billed late or skipped when a cycle closed between visits
After: Every device sits on a 30-day or 90-day calendar and is billed when its cycle closes
Before: Staff reworked denied claims one by one with no record of why they happened
After: Denials are grouped by reason every month and the cause is fixed at the source
Drag across the panel to compare.
Cardiology billing questions
Straight answers on authorization, modifiers, device billing and starting out.
30 of 30 questions
- It depends on the payer. For plans covered by the federal prior authorization rule (CMS-0057-F), payers must decide within 72 hours for urgent requests and 7 calendar days for standard ones. Commercial plans vary. We submit as soon as the test is scheduled so the decision is back before the patient arrives, and we track every request until it closes.
Start with an audit of your stress echo and device-check claims
Send your payer list, recent denial reports and a list of providers and sites. We review where cardiology claims are leaking and show you the causes.
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