1) Front-end & eligibility

We verify patient insurance, medical necessity requirements, and prior authorization needs before high-cost procedures (e.g., PCI, TAVR evaluations, complex EP procedures). Early checks reduce cancellations and surprise patient balances.

What we do:

• Real-time eligibility and benefit extraction.

• Prior-auth initiation and follow-up for imaging/therapy/device cases.

• Patient financial estimates and deposit guidance for high-cost services.

2) Procedure & clinic coding (clinical nuance matters)

Cardiology encounters range from brief device checks to multi-hour interventional procedures. We match visit documentation to the correct E/M, procedure, and time-based codes — always ensuring defensible, payer-appropriate coding.

Examples:

• Non-invasive: ECG/EKG interpretation, transthoracic & transesophageal echocardiography, stress testing, nuclear studies.

• Invasive/interventional: cardiac catheterization, PCI/stenting, coronary angiography, peripheral interventions when billed by cardiology.

• Electrophysiology: diagnostic EP studies, ablation procedures, device implantation and follow-ups (ICD, CRT, pacemakers).

• Chronic care: CCM, RPM, complex-care management and transitional care coding where applicable.

 

Note: We avoid blind code-lists. Every coding choice is cross-checked against the clinical note, consent forms, and device documentation.

3) Device, implant & supply billing

Implants and expensive supplies are a key revenue source — and a common cause of claim issues if invoices don’t match claims. We reconcile manufacturer invoices to claim line items, ensure correct C-code/TPT reporting where applicable, and attach required documentation.

Services include:

• Invoice-to-claim reconciliation.

• Manufacturer coordination and supplier enrollment checks.

• Documentation of device serial numbers and charge capture verification.

4) Remote monitoring & RPM/RHM

Remote physiologic monitoring and remote heart monitoring generate distinct codes, documentation requirements, and bundling rules. We support RPM/RHM program billing (consent, device set-up, monitoring time documentation, and monthly aggregation) to maximize appropriate reimbursement.

5) Claim scrubbing & submission (AI-assisted)

Before claims leave, automated scrubbing checks for:

• Missing modifiers or incorrect modifier use.

• Demographic mismatches and patient ID/insurance errors.

• Payer-specific edits and bundling conflicts.

• Device/implant line-item inconsistencies.

AI flags high-risk claims and ranks them for human review — reducing rejections and speeding first-pass acceptance.

6) AR workflow & denial management

Denials are unavoidable; repeat denials aren’t. We triage AR by recoverable value and address systemic causes. Our appeals team prepares clinical packets, escalates to payer reps, and, when needed, coordinates peer-to-peer reviews.

What you get:

• Prioritized AR list by $ value and likely recovery.

• Full appeals documentation with chart extracts and guideline citations.

• Monthly RCA (root-cause analysis) to prevent recurrence.

7) Reporting & provider scorecards

Monthly dashboards include:

• Days in AR, denial rate, first-pass acceptance rate.

• Procedure-level profitability and payer performance.

• Provider-level scorecards with documentation and coding feedback.

These aren’t abstract reports — they’re prescriptive: we include focused actions to improve collections.