Cardiology billing and accounts receivable

Diagnostic testing, device checks and the professional/technical split create constant component-billing errors.

Where the money leaks in cardiology

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Professional and technical components split incorrectly (26 / TC)
• Device interrogation frequency limits exceeded
• Stress tests denied for medical necessity documentation
• Nuclear studies billed without the radiopharmaceutical
• Echo billed with the wrong number of views documented

What a seat does about it

One trained person works your queue from the difficult end. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing.

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and certified coding at $2,500.

The codes those turn into

Each of these is a denial code you are likely to meet working cardiology, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-50 — Not deemed medically necessary
  The payer does not accept that the documentation supports the service. This is a clinical argument, not a clerical one.
  Recovered by being appealed with clinical documentation. Matched from: “Stress tests denied for medical necessity documentation”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and about about 90% of initially denied claims are eventually paid. Most of what sits in a cardiology AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions