Cardiology Coding Errors Can Cost You Millions, Here’s How We Prevent Them
Dr. Sarah Chen stared at the spreadsheet in disbelief. The cardiology department at had just undergone a routine audit that revealed over
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Case study · Cardiology
$360K more in annualized collections for a 4 provider cardiology practice
Denials were running at 12% and $320K sat in A/R past 90 days. Patients were paying only 73% of what they owed. Ninety days after WeBill Health took over the revenue cycle, every one of those numbers had moved.
4 providers$2.4M annual collections beforeResults measured at day 90
+$30KMonthly collections, from $200K to $230K
4.5%Denial rate, down from 12%
$155KCleared from A/R over 90 days
89%Patient balances collected, up from 73%
The practice
Care was delivered. Payment was not keeping up.
A four provider cardiology practice where a single denied imaging study or procedure can be worth more than a day of office visits. High dollar claims were sitting in A/R, and some paid claims were paid short.
| Specialty | Cardiology |
|---|---|
| Providers | 4 |
| Annual collections | $2.4M, about $200K a month |
What we found in the audit
12% of claims denied
Too many claims came back unpaid, with the same denials repeating month after month.
$320K stuck past 90 days
Earned money was sitting in aging A/R with no one working it by payer or by filing deadline.
92% clean claim rate
Too many claims needed rework before a payer would even process them.
73% of patient balances collected
Copays and balances were left behind at checkout and never recovered.
What WeBill Health changed
Six fixes before the visit, in the coding and after submission
Every claim received human pre submission review by cardiology coding experts, checked against our payer rule libraries for each carrier this practice bills.
Before the procedure
Secure authorization first
- Prior authorization confirmed before imaging and procedures
- Eligibility verified and patient balances collected at the visit
Coding
Prove medical necessity on every claim
- Procedure and E/M claims reviewed for coding accuracy before submission
- Diagnosis codes checked against payer coverage policies to stop medical necessity denials
After submission
Collect the full contracted amount
- Remittances compared with contracted rates to find underpayments
- High dollar A/R worked first, in priority order by payer
90 day results
Before and after WeBill Health
Denial rate
Lower is betterClean claim rate
Higher is betterA/R over 90 days
Lower is betterPatient balances collected
Higher is betterMonthly collections
Higher is betterEvery bar starts at zero. Figures come from the practice's own billing reports, comparing the baseline month with month three.
Where the $360K comes from
An extra $30K collected every month
Monthly collections rose from $200K to $230K by day 90. Held for a full year, that is $360K the practice collects on care it was already delivering.
The gain came from specialty specific coding and fewer days in A/R. Fewer claims were denied, and balances that had aged past 90 days were finally collected.
Monthly collections before$200,000
Monthly collections at day 90$230,000
Increase per month$30,000
Annualized increase$360,000
Net return on the WeBill Health fee161%
Net return is the annualized increase in collections, minus the annual WeBill Health fee, divided by that fee. It is calculated before any savings from the practice's previous billing arrangement.
The math
Where the $30,000 a month came from
Estimated breakdown, built from cardiology billing benchmarks and 2026 Medicare rates, tied to this practice's measured before and after figures. Each line is a claim count multiplied by what those claims pay. A/R cleared from the old backlog is reported separately and is not part of this monthly gain.
| Change | Added a month |
|---|---|
| Denials stopped before they happenedAbout 1,087 claims a month at an average of $184 collected. Cutting the denial rate from 12% to 4.5% means 82 fewer denials a month. Before, about half of denials were never reworked, so 41 of those claims are now paid that were not. | $7,544 |
| Patient balances collectedPatients owe about $20,000 a month in copays, deductibles and coinsurance. Collection rose from 73% to 89%. | $3,200 |
| Hospital echo reads billed with modifier 26Echoes the cardiologists read for the hospital that were never billed as 93306 with modifier 26, 179 a month at about $70 each. | $12,530 |
| Underpaid claims recovered114 claims a month paid below the contracted rate, short by an average of $59, now appealed and recovered. | $6,726 |
| Added collections a month at day 90 | $30,000 |
Prior authorization moved to WeBill Health as well. The AMA 2025 survey puts that work at 13 hours a week per physician, or about 52 hours a week for 4 providers. At the national median wage for medical administrative staff ($45,930 a year, BLS May 2025) plus benefits, that workload is worth about $85,298 a year in staff time.
Codes and conditions
The claims behind these numbers
| Visit type | Codes and rules | Typical conditions (ICD 10) |
|---|---|---|
| Office visit with an ECG | 99214, 93000, G2211 on Medicare follow ups | Atherosclerotic heart disease I25.10, paroxysmal atrial fibrillation I48.0 |
| Echo read in the office or for the hospital | 93306 global in the office, 93306 with modifier 26 when the hospital owns the equipment | Aortic valve stenosis I35.0, hypertensive heart disease with heart failure I11.0 |
| Nuclear stress test | 78452 plus 93015 to 93018 for the stress portion, prior authorization through the radiology benefit manager | Other chest pain R07.89 |
| Carotid duplex | 93880, needs a diagnosis that meets the coverage policy | Atherosclerotic heart disease I25.10 |
What it costs
The 5% fee against the cost of doing this in house
This practice's WeBill Health rate is 5% of collections. At $230,000 a month that is $138,000 a year. Here is what the same work costs a 4 provider practice that staffs it in house, before software and clearinghouse fees.
| Item | Per year |
|---|---|
| In house billing staff1.5 billers for 4 providers (MGMA: about one per two to three providers) at $73,160 each, the BLS median of $51,140 plus benefits | $109,740 |
| Prior authorization staff time13 hours a week per physician (AMA 2025), 52 hours a week, at the BLS median for medical administrative staff plus benefits | $85,298 |
| In house cost | $195,038 |
| WeBill Health fee, 5% of collections | $138,000 |
| Saved against in house staffing | $57,038 |
| Added collections a year | $360,000 |
| Better off each year with WeBill Health | $417,038 |
What other cardiology practices can take from this
Three cardiology billing gaps worth checking this week
Get authorization before the study, every time
Many payers require prior authorization for cardiac imaging such as nuclear stress tests. A missing authorization is one of the hardest denials to overturn after the fact.
Link the diagnosis to the coverage policy
Medicare coverage determinations list the diagnoses that support each test. A claim with a diagnosis outside that list is denied as not medically necessary.
Check paid claims for underpayments too
An underpaid claim looks resolved in most systems. Comparing each payment with the contracted rate is the only way to catch it.
Your practice next
Find out what your cardiology practice is leaving uncollected
The Revenue Defense Audit reviews your denials, aging A/R and patient collections the same way we did here. You get a written report that ranks the fixes by dollars at stake. We reply within one business day.
Questions
About this case study
How fast did the results appear?
Every figure on this page was measured at day 90, comparing the practice's baseline month with its third month on WeBill Health.
Why is the practice not named?
We protect our clients' privacy. The figures come from the practice's own billing reports.
What drove the biggest change?
The denial rate. Cutting denials from 12% to 4.5% meant far more claims were paid the first time, which lifted monthly collections and stopped new balances from piling up in aging A/R.
Does WeBill Health work with other cardiology practices?
Yes. Cardiology sits in our Procedure and Surgical billing group. Every account is handled by coding experts who work cardiology claims every day.
We bill inside the system you already use
Our billers and coders work every day in the five EHR, EMR and practice management systems most used in cardiology. You keep your software, and we take over the billing inside it.
EHR, EMR and practice management
- EPEpic
- NENextGen Healthcare
- ATathenaOne
- ECeClinicalWorks
- OROracle Health
Clearinghouses
- OPOptum
- AVAvaility
- WAWaystar
- TRTriZetto
- OFOffice Ally
Using a system that is not listed here? Tell us on the audit call. Product names are trademarks of their owners and appear here only to show the systems we work in. No partnership or endorsement is implied.
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