Cardiology revenue cycle management
Advanced imaging and device procedures carry heavy prior-auth and complex coding - that's where cardiology revenue is won or lost. AI agents match clinical criteria, split professional vs. technical, and run the whole cycle.
Cardiology's revenue is concentrated in high-value imaging and procedures that are PA-heavy and easy to miscode. AI agents assemble authorization packets that match payer criteria, code cath, EP and echo correctly, and detect underpayments - then run claims, posting, denials and collections.
Prior authorization
- Advanced-imaging & device PA - Assembles PAs for nuclear studies, CT/MR angiography and device procedures, matching clinical criteria.
- PA status polling & expiry - Polls status and tracks authorization expiry.
- Appropriate-use (AUC) matching - Checks studies against appropriate-use criteria before ordering.
- Peer-to-peer scheduling - Books and preps peer-to-peer reviews when a PA is challenged.
Coding & compliance
- Cath, EP & echo coding - Codes catheterization, EP and echo studies from the report.
- Professional/technical split - Applies modifiers 26 and TC correctly by setting.
- Bundling / NCCI check - Checks device and procedure combinations against bundling edits.
- Diagnostic vs. interventional coding - Distinguishes diagnostic from interventional services in the same session.
Eligibility & benefits
- Coverage & OOP for high-cost procedures - Verifies coverage and out-of-pocket before expensive studies and procedures.
- Secondary coverage detection - Detects secondary plans and coordinates benefits.
- Good Faith Estimate - Produces a self-pay Good Faith Estimate where required.
Claims & submission
- Claim scrubbing - Scrubs claims against payer and bundling edits.
- Report attachment automation - Attaches procedure and imaging reports to claims.
- Claim status follow-up - Polls status and chases stuck claims.
Payments, denials & AR
- ERA auto-posting - Posts remittances and adjustments automatically.
- Imaging-PA denial recovery - Auto-appeals imaging authorization denials.
- Underpayment detection - Flags procedure payments below contracted rates.
Patient collections
- Point-of-service estimate & collection - Estimates and collects patient responsibility before the procedure.
- Statements & payment plans - Sends statements and offers payment plans.
Front office
- Call answering & test scheduling - Answers calls and schedules tests and procedures.
- Referral intake & tracking - Captures inbound referrals and tracks them to a booked visit.
Analytics
- Procedure-margin & denial dashboards - Dashboards procedure margin and denial trends.
What you get
- Match payer criteria on every advanced-imaging PA
- Split professional vs. technical automatically
- Code cath, EP and echo studies from the report
- Verify out-of-pocket before high-cost procedures
- Catch underpayments on contracted procedure rates
- Recover imaging authorization denials
Frequently asked questions
What are the 26 and TC modifiers in cardiology?
Modifier 26 bills the professional interpretation of a study, and TC bills the technical component. Echoes, nuclear studies and stress tests are frequently split this way, and getting the split wrong either loses revenue or creates a duplicate-billing problem.
Why do cardiac imaging studies need prior authorization?
Advanced cardiac imaging is high cost, so most plans require authorization and often apply appropriate-use criteria. Approval usually depends on documenting the clinical indication and prior workup, which is why the authorization packet has to match payer criteria.
How are cardiac catheterization and EP procedures coded?
Both use component coding, where the base procedure is reported with additional codes for the specific interventions performed. Miscounting components or missing an add-on code is a frequent source of underpayment on high-value procedures.
What is a peer-to-peer review?
When a payer denies or pends an authorization, the ordering physician can discuss the case directly with the payer's medical director. Scheduling these quickly matters, because the authorization window and the procedure date usually will not wait.