Specialties
Medical billing for cardiology
Cardiology claims are rarely one service. A single patient can generate a visit, a test you performed, a test you only read, and a device check, each billed under different rules.
What makes cardiology billing hard
- Professional and technical components. Echocardiograms, stress tests, Holter and event monitors are billed globally, as the professional reading only, or as the technical part only, depending on who owns the equipment and where the test was done. Billing the wrong split is either a denial or money left behind.
- Medical necessity. Many cardiac tests are covered only for specific diagnoses under Medicare national and local coverage determinations. The test can be entirely appropriate and still be denied because the diagnosis on the claim doesn’t match the policy.
- Prior authorization on nuclear stress tests, cardiac CT and MRI, often managed by a separate radiology benefit manager rather than the plan itself.
- Cath lab and interventional coding. Catheter placement, injections and imaging are bundled into many procedure codes, and the bundling changes from code to code.
- Device monitoring. Remote and in-office checks of pacemakers and defibrillators have their own billing periods and frequency limits.
How we work it
We confirm who billed the technical component before the professional claim goes out, link every test to a diagnosis that the payer’s policy actually accepts, and track authorizations ahead of the scheduled date. Device monitoring is run on a calendar so that billable periods are claimed when they close rather than discovered months later.
Common questions
Can you bill for tests we read at the hospital?
Yes. When the hospital owns the equipment, you bill the professional component only and the hospital bills the technical side. We set that up per location so the right split is applied automatically.
Why are our echo and stress test claims denied for medical necessity?
Usually because the diagnosis on the claim isn’t one the payer’s coverage policy lists for that test, even when the test was clinically justified. Matching the documented diagnosis to the policy before submission fixes most of it.
Start with the free audit
Send us ninety days of claims data and we’ll show you what was left uncollected. No charge, no obligation, and the findings are yours either way.
Request my free audit