Cardiology billing lives on the modifier. 26 versus TC on every echo. Device monitoring billed monthly or not at all. Global period E/M denied without modifier 24. The interpretation is done. The procedure is done. The claim is where the cycle leaks.
A cardiologist reads an echocardiogram at the hospital. The interpretation is sharp, the report goes to the referring physician, the patient gets the right treatment. Three weeks later the claim goes out as 93306 global. The hospital separately bills 93306 TC. Both claims get denied. The practice and the hospital both submitted for technical component revenue that only one of them can claim. The right code was 93306-26, professional component only. About 70 dollars instead of 230 dollars per study. Across 150 echoes a month, the modifier error is around 90 thousand dollars a year. Walking out the door.
That is one leak. Device monitoring is the second. A typical cardiology practice has 200 active pacemaker patients, 100 ICD patients, and 50 loop recorder patients on remote monitoring. The codes are 93294, 93295, and 93298. They bill monthly or every 90 days depending on the device. Done correctly the device monitoring queue is a 60 thousand dollar a year recurring revenue line item. Most practices either do not have the queue built, or they bill in-person interrogations and skip the remote codes entirely.
Global period E/M is the third. Diagnostic catheterization has a 0-day global. Stent placement and EP ablation have 90-day globals. During the global period, any E/M visit related to the procedure is bundled. An E/M visit unrelated to the procedure requires modifier 24 to bill separately. Without modifier 24, the claim denies. With modifier 24 properly documented, the visit pays. Most cardiology practices miss 30 to 50 percent of legitimate modifier 24 opportunities because the workflow does not flag global periods at scheduling.
These are not coding mistakes. They are workflow problems. The studies happen. The procedures happen. The billing is wrong because nobody is reading the place of service against the modifier and the global period against the next visit. That is the work we do.
Pull these numbers from your practice management report. The output is what your practice should be generating in modifier 26 versus TC correction, device monitoring, and global period E/M that most cardiology practices leave on the table.
Based on CMS national average rates. Your real number is usually larger once NCCI edit corrections, downcoded 93306 vs 93308 studies, and aged AR on high-dollar procedures are included. The 48 hour audit gives you the line by line breakdown from your own data.
What a percentage based billing vendor delivers versus what a managed department delivers. The economics drive every decision about which functions run.
Sixty plus codes in cardiology scope. Search by number or filter by category. Each card has the fee range, what the code bills for, common denials, and what we look for in the note.
A managed department, not a claim submission service. Every function below runs under the same operations head, with the same KPIs, reporting into Apex.
| Function | What Quilven runs | What typical vendors do |
|---|---|---|
| Modifier 26/TC accuracy | Place of service audited against modifier on every imaging study. POS 22 paired with modifier 26 by rule. | Template default. Hospital site studies often billed globally and denied. |
| Device monitoring | Pacemaker, ICD, loop recorder queue billed monthly. 93294, 93295, 93296, 93298 by device type and interval. | Queue not built. In-person interrogations billed, remote codes skipped. |
| Global period E/M | Global periods tracked at scheduling. Modifier 24 applied when documentation supports unrelated visit. | Global period visits denied. Practice writes them off as bundled. |
| NCCI edit review | Monthly review against current CMS quarterly NCCI update. Bundling corrected before claim submission. | Clearinghouse flag. No active correction. Denials accepted. |
| Prior authorization | Cath, EP procedures, device implants tracked. Submitted, followed up, escalated when delayed. | Clinical staff handles auth. Out of scope for the vendor. |
| Diagnostic + intervention | Same-day diagnostic cath plus intervention coded with proper sequencing. Add-on codes captured. | Sequencing varies by claim. Add-on revenue inconsistent. |
| Aged AR on procedures | High-dollar procedural claims over 90 days worked first. Appeals to round three or four. | Aged claims written off. First appeal sent, then silence. |
| Credentialing + hospital privileging | CAQH, PECOS, and hospital privileging tracked on a live master sheet. Target 90 days payer billable. | Payers tracked. Hospital privileging treated as a side task. Non-billable months not flagged. |
Eight questions. No email required. The result is written for cardiology, with the specific line items leaking based on your answers.
The questions practice administrators actually ask before signing with a billing company.
Three fields. We get back to you the same business day. The 48 hour audit gives you a line by line breakdown of what is recoverable from your last 90 days of claims, by CPT code and by payer.
No commitment. No pitch deck. If your cycle is clean you get outside confirmation. If it is not you get a real number from your own data.
Where do we send the findings.
A senior member of the team will reach out within the next business hour. Watch your phone.
Line by line, by code, by payer, by month. Specific to cardiology. Specific to your practice.