How to Find the Best Cardiology Billing Partner: Critical Questions to Ask

In the current fast changing nature of heath care, it has become very difficult to meet the billing demands – especially in cardiology. A recent change by the Centers for Medicare and Medicaid Services (CMS) offers a perfect example: New 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) meaningfully raises the payment amounts for CCTA exams. This change incorporates CCTA into a more rarified APC 5572 increasing from $175 to $357.13 more than double.

This would sound like a somewhat positive note, however, what this statement unveils is the enormous challenge of grappling with reimbursement systems and the importance of having implementing sound cardiology billing and coding methods.

While outsourcing your cardiology billing has emerged as a plausible and preferable strategy for most of the providers, how to find the right billing partner has become a major concern for the providers.

4 Questions to Ask Your Potential Cardiology Billing Partner

What is your experience and expertise?

Cardiology services have detailed billing and coding because of the many procedural and diagnostic services done within the specialty. Find out how much your potential billing partner knows about cardiology billing services and coding guidelines. A partner with such specialization will make sure that your process is error-free, and cash flow is optimized.

Learn about your potential partner’s industry experience and consider analyzing client references to understand their expertise and capabilities.

How do you handle cardiology prior authorization services?

When submitting claims, you must take great care to ascertain that these claims are agreed beforehand with the insurer. Ask your prospective billing partner how they operate in the prior auth. An ideal partner will facilitate this process by taking care of most of the work, keeping the focus of your organization where it belongs - taking care of patients.

What Are Your Fees and Payment Structures?

The various cardiology billing services use different pricing models. Most charge flat rates, but others work on a percentage of collected revenue. Ensure that you understand what they're charging and any additional fees that may crop up. Compare that to the kind of service you are going to get, the level of expertise involved, making sure the value comes out in the cost.

How do you keep abreast of changes in regulations?

The landscape of health-care billing is always changing, and compliance with such regulations is of the essence. Ask your would-be billing partner how they ensure that they are updated on the latest in Medicare, Medicaid and other insurance policies. A competent cardiology billing partner will not miss reviewing updates from the CMS and other payers to ensure that the practice is kept up to date to ensure optimal reimbursement.

Conclusion

The right cardiology billing partner is crucial for the success of your bottom line. Asking the right questions and making sure that your billing partner is prepared for complex tasks such as prior authorizations, denials, and regulatory updates will safeguard your practice's financial health and allow you to focus on delivering the best care possible to your patients.