Did you know that there are nearly 47,225 cardiologists in the U.S.? These include 9,594 interventional, 4,328 electrophysiology, and 973 heart failure (HF) physicians.
Undoubtedly, cardiology is a highly complex specialty, and management of its revenue cycle matches its reputation. Thus, we decided to dedicate this guide to discussing cardiology revenue cycle management (RCM) guidelines.
It will cover the key challenges, best practices, and list the top EHR software. So, continue reading!
Revenue Cycle Management Challenges for Cardiology Practices
Some of the key challenges that cardiologists face are discussed below:
Complex Coding and Ever-Evolving CPT Standards
Cardiology revenue cycle management is already a complex task. Besides, the high volume of subspecialty codes, such as structural heart and electrophysiology, and frequent updates, only adds to the intricacies.
Every year, the American Medical Association (AMA) introduces new procedural codes and descriptors. In 2026, the organization added 288 new codes, deleted 84 codes, and revised 46 codes.
Listed below are the key updates related to cardiology codes:
- Six add-on codes (92921–92944) are removed for branch vessels. Moreover, interventions are bundled into revised primary codes or new complex categories.
- CPT code 92930 is added for bifurcation or multiple distinct lesions in one vessel. Besides, it offers approximately 20% higher relative value unit (RVU) than standard stenting.
- CPT code 92945 for chronic total occlusions has also been added. It combines antegrade and retrograde approaches for revascularization.
- AMA also replaced 16 old codes with 46 territory-based codes (37254–37299) in the 2026 CPT book. The book organizes these codes based on the four specific vascular regions, i.e., iliac, femoral/popliteal, tibial/peroneal, and inframalleolar.
- That’s not all, these codes (37254–37299) arrange interventions by straightforward (stenosis) vs. complex (total occlusion). Additionally, they bundle access, catheterization, and all intraprocedural imaging into the primary codes.
- New Category III codes (0992T/0993T) added for AI analysis of perivascular fat. Besides, AMA added category I code 75577 for AI-based coronary plaque quantification from computed tomographic angiography (CTA).
- The 2026 CPT update reduces the billing threshold for remote monitoring management to 10 minutes per month.
These updates are only a part of the coding complexity. There are modifiers and diagnosis codes (ICD-10) as well that often make cardiology revenue cycle management even worse.
That is, a single missing modifier or a vague ICD-10 diagnosis can trigger an automatic medical-necessity denial. Yes, an error like this can stall your rightful reimbursements, negatively impacting your cardiology revenue cycle.
Intense Prior Authorization Burdens
Many cardiovascular procedures, such as ablations, cardiac CTs, and nuclear stress tests, are expensive, leading to high scrutiny from payers.
Moreover, payers often update their policies for these services without prior notice. For example, a procedure that required no authorization last month may require pre-authorization or specific imaging results.
The outcome? Because of these requirements, healthcare providers are spending twice as much time on paperwork as they are on patient care. This is the direct contributor to physician burnout.
Besides, every hour the cardiologist spends waiting for a pre-authorization, the procedure is postponed. This not only delays critical services but also stretches accounts receivable (AR) days, straining the cardiology revenue cycle.
High-Value Underpayment
Cardiac procedures involve expensive inventory, including catheters, valves, and devices. As a result, an underpayment of even 2% per medical claim can lead to significant cardiology revenue cycle losses.
But why does it happen? Insurance payers often fail to update their fee schedule to match the practice’s latest contract or use a silent preferred provider organization (PPO) discount.
Besides, most of the time, practices do not have software to perform contract modeling. That is, with no means to validate if a $20,000 payment for a stent actually matches their negotiated rate, it becomes even more challenging to ensure a healthier cardiology revenue cycle.
Best Practices for Cardiology Revenue Cycle Management
Discussed below are the best practices to optimize your cardiology practice’s revenue cycle:
Front-End: Automated Financial Clearance
Cardiology has some of the strictest pre-authorization requirements. However, implementing the following best practices will help you streamline the front-end of cardiology RCM:
Real-Time Eligibility (RTE)
Utilize AI-driven tools at patient check-in. It will help you verify active coverage and specific cardiology benefits, such as the allowed billable frequency of echocardiograms per year.
Automated Prior Authorization Workflows
The majority of cardiology procedures require prior authorization. Therefore, you should implement robotic process automation (RPA) to check authorization status on payer portals after every four hours.
How will it help? It will prevent last-minute cancellation scenarios.
Mid-Cycle: Precision Coding & Documentation
For mid-cycle cardiology revenue cycle management, coding accuracy should be your top priority. Here’s how you can achieve it:
Hire Certified Professional Coders (CPCs)
Only CPCs specialized in cardiology coding. Why? General coders may miss the nuances of complex percutaneous coronary intervention (PCI) bifurcation or electrophysiology (EP).
Focus on Clinical Documentation Improvement (CDI)
Invest in continuous education and training of physicians focused on CDI. It will help them document medical necessity triggers, such as ejection fraction percentages, effectively in the first 20 lines of the operative report.
Ensure Appropriate Modifier Usage
Update your claim scrubber software to include a ‘hard edit’ for modifiers 59 (distinct service), TC (technical component), and 26 (professional component).
How will it help? It will ensure that these modifiers are applied only when the clinical documentation supports unbundling. This will result in a few modifier-related denials and a healthier cardiology revenue cycle.
Back-End: Intelligence-Driven AR Management
Since cardiac services are highly expensive, even a single claim denial can significantly disrupt your monthly cash flow. Thus, you must implement the following back-end cardiology RCM best practice to limit the denial occurrences:
High-Value Prioritization
Configure your AR dashboard to flag any unpaid claim over $5,000 as high priority as soon as it hits 15 days old.
Maintain a 5% Denial Threshold
Aim for a denial rate that is less than 5%. In case it exceeds the threshold, perform a root cause analysis specifically focusing on breached National Correct Coding Initiative (NCCI) edits or misuse of modifiers, like 51.
Underpayment Detection
Integrate a contract modeling software to flag any reimbursement that deviates by 1% from the negotiated fee schedule.
Best EHR/EMR Software for Cardiology RCM
The following is a list of features that a cardiology EMR/EHR system should have:
- Deep Diagnostic & Imaging Integration
Cardiology is a data-heavy specialty. If your EHR cannot integrate with your equipment, your staff will waste hours on manual data entry. Thus, ensure that the cardiology EHR you select has the following features:
- PACS/DICOM support to view and store high-resolution images.
- Direct device interfacing that connects with spirometers, Holter monitors, and EKG machines. It is integral, so results flow directly into the patient’s chart.
- The cardiology EHR should automatically pull discrete data, such as valve measurements from the imaging machine, into the clinical note.
- Cardiology-Specific Templates
Look for an EHR system that has pre-built cardiology templates, like pacemaker/ICD follow-ups, heart failure, etc. That’s not all, your cardiology EHR must also have the following capabilities:
- Ability to document complex interventional procedures, such as ablations, using cardiology-specific terminology.
- Built-in alerts for cardiology-specific medications.
- Remote Monitoring & Implantable Support
Your EHR must act as a hub for external data to support remote patient monitoring (RPM) and implants. Thus, look for a cardiology EHR with:
- A dedicated module for RPM that captures blood pressure and weight data from cellular-enabled home devices.
- Capability to import and track data from vendor portals so you can review device interrogations inside the chart.
Top 5 EHR/EMR Systems for Cardiologists
The table below shows the best cardiology EHR systems:
| EHR/EMR System | Features |
|---|---|
| Merge Cardio (IBM) | Image-sharing capabilities Improved user inter faceAI-enhanced diagnostics |
| AdvancedMD | Cardiology-specific templatesComprehensive practice managementIntegrated telehealth services |
| Objective Medical Systems (OMS EHR) | Enhanced reporting modulesIntegration with wearable devicesAI-driven insights |
| DrChrono | Enhanced mobile accessImproved patient portal |
| AthenaHealth | Integrated cardiology RCM software‘Hey Athena’ voice assistantAutomated patient engagement |
Outsource Cardiology RCM to MediBillMD
Are you worried because of an unsteady cash flow and revenue leakage? Outsource cardiology revenue cycle managementservices to MediBillMD to enhance your practice’s financial performance.
But wait, what makes MediBillMD the best choice? We have processed 0.5 million claims and increased revenue by 10-12% by correcting revenue leakage factors for 5,000 practices nationwide.
Additionally, our expert team is well-versed in all leading cardiology EHR/EMR software. As a result, you can enjoy complete peace of mind while performing the complex procedures, while we take care of the financial aspects.
