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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.
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.
Secure authorization first
- Prior authorization confirmed before imaging and procedures
- Eligibility verified and patient balances collected at the visit
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
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.
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.
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 Health 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.