# Cardiology Case Study

> See how WeBill Health defended revenue for a cardiology practice with prior authorization control, diagnostic coding precision and denial defense.

Source: https://webillhealth.com/case-studies/cardiology/  
Publisher: WeBill Health  
Last updated: October 27, 2026

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

**+$30K**Monthly collections, from $200K to $230K

**4.5%**Denial rate, down from 12%

**$155K**Cleared 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 better

Before**12%

After**4.5%

### Clean claim rate

Higher is better

Before**92%

After**98%

### A/R over 90 days

Lower is better

Before**$320K

After**$165K

### Patient balances collected

Higher is better

Before**73%

After**89%

### Monthly collections

Higher is better

Before**$200K

After**$230K

Every 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.

[Request a Revenue Defense Audit](https://webillhealth.com/audit)[See all specialties](https://webillhealth.com/specialties/)

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.

[Request a Revenue Defense Audit](https://webillhealth.com/audit)[Check my Revenue Defense Score](https://webillhealth.com/revenue-defense-score/)

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.

WeBill Health is a specialty focused revenue cycle management partner for independent practices. Request a Revenue Defense Audit at https://webillhealth.com/form/