Cardiology Invoicing Software

Invoicing in a Cardiology Practice

Claims still carry most of a heart practice's revenue, so invoicing begins with them. Each claim is formatted to the payer's rules and sent through the clearinghouse. But a heart practice also bills outside the claim. A group that supervises a hospital's nuclear lab bills the hospital under a service contract, since Medicare pays the hospital for that work. A nursing facility whose Part A resident had a nuclear study pays the practice for the technical part, because the facility bills Medicare for it. A research sponsor pays for the study visits and tests the trial covers. A self-pay patient gets an invoice that matches the estimate they received. Each of these is drawn from the same account record by the cardiology invoicing software. It sends patient invoices by email or text, keeps contract and sponsor invoices on their own schedules, and shows every claim and invoice in one view until paid.

Why Is Invoicing Different in Cardiology?

A heart practice often works inside other organizations. Its cardiologists may direct a hospital's nuclear lab, cover call, or read studies under contract. Medicare pays the hospital for some of that work, such as supervision, so the practice can't bill Medicare for it. The practice is paid by invoicing the hospital under the agreement, and those invoices need the same care as any claim.

Research is part of many cardiology programs. Structural heart, device and drug trials often pay for study-only visits and tests, while Medicare covers routine care billed with trial modifiers. A practice that sends a sponsor's tests to Medicare risks a refund. A practice that forgets to invoice the sponsor loses income. Invoicing in cardiology has to split each trial patient's care correctly between the two.

Patient bills can be larger than patients expect. A self-pay calcium score, or an echo under a high deductible, can surprise a patient. Uninsured and self-pay patients must get a good faith estimate for scheduled care, and their invoice should match it. When Medicare denies a service the patient agreed to pay for on an ABN, the patient invoice should show why.

What Cardiology Invoicing Software Handles

Hospital supervisory and administrative services

Medicare pays the hospital, as a provider service, for physicians' administrative or supervisory radiology services to the hospital. Practices that supervise a hospital nuclear lab bill that work to the hospital by invoice. (CMS Medicare Claims Processing Manual, Chapter 13 (Radiologic Services), section 20.2.1: Hospital and SNF Patients)

Imaging for skilled nursing facility residents

Medicare Part B does not pay for the technical part of radiology services to SNF residents in a covered Part A stay, and the SNF bills it instead. The practice invoices the SNF for the technical part and bills only the professional read. (CMS Medicare Claims Processing Manual, Chapter 13 (Radiologic Services), section 20.2.1: Hospital and SNF Patients)

Clinical trial routine costs

Medicare claims for routine costs in a qualifying trial carry the trial number, diagnosis Z00.6 and modifier Q0 or Q1. Staff split each trial visit, so study-only services covered by the sponsor's contract are invoiced to the sponsor. (CMS Medicare Claims Processing Manual, Chapter 32, section 69: Qualifying Clinical Trials)

ABN patient liability (GA)

Under WPS policy, pacemaker claims that don't meet coverage criteria carry GA or GZ and are denied. With GA and a signed ABN, the denied amount can move to the patient's invoice. (CMS Medicare Coverage Database, WPS Billing and Coding Article A54958: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers)

Self-pay estimate check

CMS says patients who aren't using insurance must get a good faith estimate for care scheduled far enough ahead. The self-pay invoice is compared with the estimate before it is sent. (CMS Medical Bill Rights: Good faith estimate guide for patients who are not using insurance)

How Does Cardiology Invoicing Software Work?

1. 1. Sort each charge by who pays

   Each charge is routed to the payer, the hospital, a facility, a sponsor or the patient. Contract terms and trial budgets set which charges go where.

2. 2. Send payer claims

   Claims for payers go out through cardiology medical billing. Their status shows next to the invoices for the same account.

3. 3. Build contract and facility invoices

   Hospital and SNF invoices are built from the services each agreement covers. Each invoice lists the dates, the services and the contract rate.

4. 4. Invoice sponsors and patients

   Sponsor invoices follow the trial budget. Patient invoices go out by email or text with a link to pay, and balances follow the patient to cardiology patient billing.

5. 5. Track every bill to payment

   Claims and invoices sit in one view by payer type and age. Overdue invoices are flagged for follow-up in AR management.

Cardiology Invoicing Software vs. Generic Software

Who Uses It in a Cardiology Practice

• Billing manager: One view of claims and invoices, with overdue contract and sponsor invoices flagged.
• Research coordinator: Trial visits split between the sponsor invoice and the Medicare claim, with the trial data on each.
• Physician owner: Contract income from hospitals and facilities tracked as closely as claim revenue, with totals passed to healthcare accounting.