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Medical Billing Case StudyEmpowering Cardiology Excellence: A Revenue Cycle Transformation
Discover how our expert revenue cycle management solutions transformed a cardiology group in Florida by streamlining prior authorization workflows, accelerating claim submission, and delivering remarkable financial growth.
Our Client
In 2015, we partnered with a four-provider practice specializing in cardiovascular treatments and interventional cardiology. At that time, they had a revenue generation of $1.7 million annually. Referred by another successful Billed Right client, this cardiology group sought an experienced RCM partner to help grow their practice, expand cash flow, align their AR, and meet ambitious business expectations.
Uncovering Opportunities
Billed Right conducted a comprehensive analysis of the entire revenue cycle, reviewing the practice workflow from scheduling and insurance benefit verification and prior authorization to coding practices, claim generation and submission, payment posting, claim denial management, and patient financial billing. Three key challenges emerged that were driving revenue leakage across the practice.
Challenges & Our Strategy
What was holding this practice back, and how Billed Right responded.
Inadequate Process for Obtaining Prior Authorizations
The practice had no systematic process for managing prior authorizations, resulting in claims denied for missing or expired authorizations, revenue leakage on high-value interventional procedures, and unnecessary administrative burden on clinical staff.
We identified loopholes in the prior authorization process and took full ownership of the workflow. We implemented a systematic approach to check plan policies, establish treatment-specific authorization lists, and adhere to clinical guidelines for each patient encounter. We educated clinical staff on documentation requirements, created tracking systems for authorization status and expiration, and built a proactive follow-up process. This allowed the practice to focus on patient care while improving PA-related revenue capture.
Charging and Claim Submission Delays
The practice was experiencing significant delays between date of service and claim submission, resulting in increased AR days, timely filing risks, and cash flow disruption that was compounding month over month.
We established a target of submitting all claims within 24-72 hours from the date of service. By reviewing the internal practice workflow, we identified that clinical notes were not being signed in a timely manner, creating a bottleneck before billing could begin. We educated the clinical team on the financial impact of unsigned notes, provided coding support, created an updated superbill, and built templates in the practice management system to streamline documentation. This restructured workflow eliminated submission delays and ensured consistent, timely claim filing.
Inefficient Coding
Inaccurate coding, particularly for peripheral interventions, interventional services, and imaging, was resulting in underpayments, denials, and reduced practice profitability. The practice lacked awareness of how to apply current cardiology coding updates and guidelines.
We reviewed the practice coding workflow in detail and provided structured feedback through our internal clarifications system. We educated the clinical team on accurate coding for peripheral interventions, component coding, appropriate billing for vessels, distinct interventional services, and imaging. We provided procedure-specific note templates to improve documentation quality and highlighted the critical importance of accurate IHR and TMI data entry. We implemented ongoing coding education as a continuous program because cardiology coding changes regularly, and staying current is essential to accurate reimbursement and audit protection.
The Results
Why This Client Chose Billed Right
Strategic Billing Expertise in Cardiology
Cardiology billing involves subspecialty-specific procedures, modifier complexity, and constant coding updates. The practice needed a partner with proven cardiology billing depth, not a generalist.
A Partner, Not Just a Vendor
Billed Right engaged as a true operating partner, educating the clinical team, rebuilding workflows, and creating sustainable billing infrastructure that scales with the practice.
Ongoing Commitment
We continue to work with this client on:
- Continuous coding education and cardiology-specific coding updates
- Prior authorization management and expiration tracking
- Claim submission turnaround monitoring
- Denial management with cardiology-specific appeal strategy
- Monthly and quarterly performance reporting
- Provider education on documentation and modifier usage
Common Questions About This Case Study
The practice faced three core challenges: an inadequate process for obtaining prior authorizations that led to denied claims on high-value interventional procedures, significant delays between date of service and claim submission that inflated AR days, and inefficient coding on peripheral interventions, interventional services, and imaging that caused underpayments and denials.
Billed Right took full ownership of the prior authorization workflow, implementing a systematic approach to check plan policies, establish treatment-specific authorization lists, and adhere to clinical guidelines for each patient encounter. The team also educated clinical staff on documentation requirements and built tracking systems for authorization status and expiration, with proactive follow-up before authorizations lapsed.
Billed Right established a target of submitting all claims within 24 to 72 hours from the date of service. Achieving that turnaround required identifying that clinical notes were not being signed in a timely manner, then educating the clinical team on the financial impact of unsigned notes and building templates in the practice management system to remove that bottleneck.
Cardiology billing involves subspecialty-specific procedures, complex modifier usage, and coding guidance that changes regularly, particularly for peripheral interventions, component coding, and imaging. Inaccurate coding in these areas directly causes underpayments and denials, which is why Billed Right treats coding education as an ongoing program rather than a one-time fix.
Billed Right runs continuous, structured coding education for the clinical team rather than treating training as a single event. This includes procedure-specific note templates, internal coding clarifications, and ongoing guidance on component coding, appropriate billing for vessels, distinct interventional services, and imaging as cardiology coding guidelines evolve.
Related Resources
Cardiology Billing Services
Learn how Billed Right handles billing for cardiology practices.
Learn morePrior Authorization Services
See how we manage authorizations for high-value procedures.
Learn moreDenial Management
How we systematically reduce denials across every practice.
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