We know why your 93306 got flagged — and how to prevent it
Cardiology Medical Billing and Coding Services
We know why your 93306 got flagged — and how to prevent it
Cardiology Medical Billing and Coding Services
Cardiology billing is complex — rapid CPT changes, NCCI edits, and frequent denials on high-value codes like 93306 and 93015 put pressure on revenue integrity. Many practices lose up to 15% of reimbursements due to missed modifiers, incorrect E/M leveling, or carrier-specific bundling rules. Horizon Healthcare RCM helps reduce denials, shorten AR days, and capture full reimbursement for cardiology procedures — all with coding accuracy above 98%.
- 12–18% Reduction in Denials
- CPT 93306 & 93015 Approved >96% First Pass
- 21-Day Average AR Cycle
Recover Cardiology Revenue Before It Ages Out
AR loss in cardiology doesn’t happen in big events — it leaks through ignored payer edits, unflagged bundling logic, and “resolved” claims missing modifier reconciliation or LCD compliance.
By day 30, most billing teams have moved on. But carriers are still rerouting, downgrading, and suppressing payment behind the portal — especially on procedures tied to image reads, global periods, and nuclear scans.
Where Cardiology Revenue Disappears
- Global-period services denied post-op because -24 modifier logic was never validated
- 72-hour bundling triggers silent denial on nuclear stress tests performed before admissions
- Denials labeled “medical necessity not met” with no supporting NCD or local LCD rebuttal
Horizon Healthcare RCM tracks payer edit logic in real time, maps denial cause to documentation, and forces line-item follow-through — because unresolved cardiology claims aren’t aged out, they’re unfinished.
Pain Billing Risks We Monitor
Global-period errors unflagged by default claim logic
Bundled diagnostics written off without modifier review
26/TC code splits unreconciled at rework stage
LCD-based denials left unresolved post-adjudication
Payer adjustments posted without EOB match or follow-up
Medical Billing Services Across Your Entire Cardiology Billing Cycle
Our team checks 72-hour global windows on imaging and ensures stress test pre-auth flags are aligned with cardiology payer policies before submission.
Capture Clean Documentation
We coach clinics to document symptom linkage for diagnostics like echo and nuclear studies, preventing common LCD-based downgrades for lack of medical necessity.
Submit With Precision
We pair CPT codes with E/M and imaging logic to avoid silent bundling denials — like 93015 auto-rejections due to same-day hospital overlap
Monitor EHR Integration
In eClinicalWorks and Athena, we reconcile order-to-bill gaps that cause “missing supervising provider” errors on 93306 and similar dual-split procedures.
Track Every Claim
Cardiology claims are tagged with modifier and place-of-service logic; our system flags mismatches common in cath lab and ambulatory surgical center submissions.
Resolve Denials Fast
We maintain payer-level appeal templates for denied cardiology billing codes — including modifiers -26, -TC, -59 — mapped against NCCI and LCD policy logic.
Manage AR Intelligently
We flag cardiology AR by denial type — especially bundling, duplicate logic, or global-period conflicts — and resolve within 21-day post-reject cycle.
Report What Matters
Our dashboards break down denials by CPT family (e.g. echo, nuclear, cath) so you can target the exact code clusters affecting cash flow.
Recent Audit Trends Every Cardiology Practice Should Know
Our audits across U.S. cardiology groups reveal critical billing errors, missed revenue, and silent denials that repeat month after month — and remain mostly uncorrected.
- 43% of echo denials lacked proper documentation
- 29% of stress test claims had modifier conflicts
- 3 in 5 bundled diagnostics were never appealed
- $1,200+ lost monthly per provider due to miscoding
- 40% of denials go untracked after first rejection
- 22% of AR sits unresolved past 45 days
- Technical fees often missed in dual-location setups
- Hospital crossover timing caused frequent claim suppression
- Pre-auth failures spike around new CPT implementation
- LCD mismatches remain top cause of Medicare denials
Horizon Healthcare RCM corrects what others miss — with billing logic, documentation strategy, and follow-up systems designed to stop revenue loss before it starts.
Is Your Cardiology Billing at Risk?
Run this 5-point check — if you say yes to 2 or more, it’s time to act.
Subspecialty Cardiology Billing. Zero Gaps. Full Reimbursement
We connect cardiology medical billing with clinical workflows to capture full reimbursement across procedures, diagnostics, and EHR-driven cardiology billing services.
Clinical Scenario
Pacemaker and lead revision were performed in an outpatient setting with intraoperative testing and device check
- Multi-component procedure involving a generator, leads, and intraoperative testing
- Device check performed the same day with remote monitoring setup
- Care delivered in ASC with supervision requirements
Billing Scenario
Horizon Healthcare RCM applies structured coding logic to prevent EP revenue loss
- CPT chains and POS matched to the generator and lead services
- Modifier -59 and global rules applied based on timing and location
- Remote and device checks captured using EHR integration
Clinical Scenario
Stents placed in two vessels following diagnostic cath during same-day hospital admission
- Multi-vessel intervention using imaging and IVUS support
- Diagnostic cath was performed pre-intervention for the same condition
- Full encounter includes stent placement and post-procedure review
Billing Scenario
Horizon Healthcare RCM codes vessel-level work and prevents bundling issues
- Diagnostic and interventional CPTs are separated using NCCI logic
- Multiple stents billed correctly with modifiers across vessels
- Cath-to-PCI links established to avoid auto-denials
Clinical Scenario
Nuclear stress test completed before inpatient admission with documented symptoms and image reads
- The patient underwent a stress test three days before admission
- Imaging performed with contrast and physician interpretation
- Full supervision and camera time documented in clinical notes
Billing Scenario
Horizon Healthcare RCM ensures imaging and stress tests pass the bundling logic
- Tracks 72-hour window bundling risk for pre-admit tests
- Applies split billing for -26 and -TC using provider records
- Aligns ICD and symptom logic to prevent LCD rejections
Clinical Scenario
T&A and bilateral myringotomy with tubes done in same operative session.
- Patient evaluated in clinic, admitted for TAVR, then followed up post-op
- Pre-op included echo, risk scoring, and shared decision-making
- Follow-up in clinic falls within the global billing period
Billing Scenario
Horizon Healthcare RCM manages global billing windows and pre/post-op separation
- Modifiers -24 and -57 used for E/M in post-op window
- Pre-auth verified and tied to CPT for pre-op diagnostics
- EHR claims flagged for timing and global-rule conflicts
Our Work Across Pain Management Practice Models
Different cardiology setups deal with different billing issues — from modifier conflicts to global-period overlap. Here’s how we handle the most common practice types.
Billing spans inpatient, clinic, and outpatient settings. This model needs tight control over global days, same-day conflicts, and cross-location modifiers — especially with cath and echo procedures.
Most revenue risk sits in documentation and CPT support. Focus is on making sure ICDs justify procedures like stress tests and echoes. LCD checks are done before claim submission, not after rejection.
We monitor department billing inside one EHR to prevent split claims duplicate denials and code overrides using shared rules that protect ENT services from allergy conflicts
Place-of-service mismatches are the biggest trigger. We apply logic for -26 and -TC splits tied to specific service locations and capture technical + professional components cleanly.
Legacy vendors miss denial trends and code relationships. We go line-by-line to flag AR that’s unresolved — not just unpaid — and rework claims where global rules or modifier gaps caused loss.
Built to Handle Every Cardiology Payer Type
Medicare flags global errors. Commercial payers bundle incorrectly. MCOs reject missing links. We apply logic specific to each plan — before the claim goes out.
Applies federal claim rules tied to diagnostics and timing.
- Monitors LCD-triggered rejections for echo and stress
- Applies MUE edits on high-frequency cardiology CPTs
- Verifies claim sequence across shared global periods
- Tracks Part B denial types by service category
98.3%
Modifier accuracy maintained across Medicare cardiology claims with LCD logic pre-applied.
Manages bundling logic and auto-denials by carrier system.
- Blocks stress/EKG code pairs flagged by default rules
- Aligns service location to CPT/POS expectations
- Detects carrier-based edits on multi-stent claims
- Matches NPI roles to carrier setup for billing approval
96.55
First-pass approval rate for high-volume CPTs like 93015 and 93306 across top commercial payers.
Accounts for state-level limitations and MCO documentation needs.
- Flags encounter-level errors from plan-specific guidelines
- Maps CPT limits against pre-auth thresholds
- Identifies mismatch in referring vs. rendering logic
- Filters claims against known MCO system denials
94.8%
Cardiology claims submitted with full compliance to state-level coding and unit limits.
Focuses on causality, timeline logic, and billing sequence.
- Applies injury-first logic to every CPT on file
- Avoids duplicate service flags from overlapping care
- Links each claim to the approved incident report timeline
- Checks payer policy on interim vs. final coding
92.4%
Clean claim rate on cardiology services tied to verified injury date and treatment sequence.
How Cardiology Practices Grow After Switching to Horizon Healthcare RCM
Cardiology billing issues don’t fix themselves. But when practices move to Horizon Healthcare RCM, they see real changes — not just in coding accuracy, but in denial rates, AR cycles, and revenue retention.
Before: 23% Denial Rate
After Horizon Healthcare RCM: 9%
Denials dropped after we corrected bundled CPTs and applied modifier logic on echo and stress test claims.
Before: 47-Day AR Cycle
After with Horizon Healthcare RCM: 21 Days
Our payer-linked worklists cut rework time and resolved global-day rejections before they aged out.
Before: No LCD Checks in Place
After with Horizon Healthcare RCM: 98.3% LCD Compliance
We built CPT-to-diagnosis mapping tied to Medicare LCDs — preventing common rejections on diagnostics.
Before: 3+ Missed Pre-Auths per Month
After with Horizon Healthcare RCM: <1 Monthly
Pre-auth triggers now run before claim prep — especially for stress tests, nuclear studies, and outpatient imaging.
Before: $900+ Monthly Revenue Loss per Provider
After with Horizon Healthcare RCM: Documented $0 Leakage
Captured technical fees, missing modifiers, and billing conflicts that were going unresolved for months.
Want These Results In Your Cardiology Practice?
You’ve seen the numbers. Lower denial rates. Faster AR cycles. Full reimbursement with no leakage. Horizon Healthcare RCM delivers the billing accuracy your cardiology practice deserves — with logic that works across payers, CPT chains, and EHRs. You could be next.