Cardiology Payment Posting Software

Payment Posting in a Cardiology Practice

A single cardiology 835 can mix very different payments. An office echo (93306) may pay as a global service. A hospital echo read by the same physician pays only the professional component, billed with modifier 26. A nuclear stress test can pay the imaging, the stress test codes and the stress agent on separate lines. Payment posting starts when the file arrives from the clearinghouse and balances to the check or EFT total. Each line is then matched to the charge it pays, with its modifiers and units. Medicare reduces the technical component of later diagnostic cardiovascular tests that one group bills for a patient on the same day, so a CARC 59 adjustment is checked against the line it should hit. Regadenoson (J2785) is paid per 0.1 mg unit, so paid units are compared with billed units. Remote device checks post to the period they cover. Short pays go to an underpayment queue, and zero-pay lines go to denial work.

Why Is Payment Posting Different in Cardiology?

Component billing makes cardiology remits harder to read. Many cardiac tests have a technical and professional split. When the practice owns the equipment and reads the study, it bills the global code. When the test runs in a hospital, the physician bills with modifier 26 and the hospital bills the facility side. One CPT code can pay three different amounts from the same payer. A poster who checks only the check total cannot see that a global claim was paid at the professional rate.

Stress testing adds its own code logic. Codes 93016, 93017 and 93018 split a stress test into supervision, tracing and interpretation, while 93015 covers all three as one global code. The NCCI manual treats the IV start and the injection for a drug-induced stress test as part of the test itself. The stress agent, such as regadenoson, is billed by HCPCS unit. Under Medicare Part B it is a single-dose drug that carries the JZ or JW modifier. Each of those lines pays on its own basis.

Device clinics bring a steady stream of small, recurring payments. Remote checks of pacemakers and ICDs are paid once per monitoring period, and a second claim in that period is often denied. Recoupments for past periods show up as takebacks on new remits. Posting has to tie each payment and each takeback to the right device period. If it does not, a denial looks like a payment error and a payment error looks like a denial. Lines that need an appeal should move straight to cardiology denial management with their reason codes.

What Cardiology Payment Posting Software Handles

PC/TC indicators and modifiers 26 and TC

Each paid line is compared with the component that was billed. A global echo paid at the professional rate, or a modifier 26 line paid as global, is flagged before it is accepted. (Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners (PC/TC indicators))

CARC 59 on diagnostic cardiovascular tests

Under Medicare, codes with multiple procedure indicator 6 have the technical component cut on the second and later tests for a patient on the same day. The multiple-procedure adjustment is checked against the lower-valued test, not the highest one. (CMS Recovery Audit Program, Approved Issue 0182: Reduction of Technical Component, Diagnostic Cardiovascular Services)

Stress test codes 93015 to 93018

When the practice supervises and reads a hospital stress test, 93016 and 93018 post as two professional lines. A payment on 93017 belongs to the entity that ran the equipment, so it is not expected on a hospital case. (Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners (PC/TC indicators))

Regadenoson units (J2785)

Regadenoson is billed per 0.1 mg, so a 0.4 mg dose is four units. Paid units are compared with billed units. For Medicare Part B the line also needs JZ or JW, because CMS lists J2785 as a single-dose drug. (CMS: Discarded Drugs and Biologicals, JW Modifier and JZ Modifier Policy HCPCS Codes)

Remote interrogation (93294, 93295, 93296)

A Novitas billing article for Medicare says these codes are reported no more than once every ninety days. Payments post against the device period they cover, so a frequency denial on a second claim is easy to spot. (CMS Medicare Coverage Database, Billing and Coding Article A56602: Cardiac Rhythm Device Evaluation (Novitas))

835 PLB provider-level adjustments

Provider-level adjustments are split out by the claim they refer to. Staff see which earlier device period or test the money came back from. (X12 transaction sets, including the 835 Health Care Claim Payment/Advice)

How Does Cardiology Payment Posting Software Work?

1. 1. Balance the file

   Each 835 is checked against its payment total before anything posts. A file that does not balance stops and goes to the poster with the gap shown.

2. 2. Match by component

   Lines are matched to the CPT code, modifier 26 or TC, units and site of service on the charge. A global charge paid as professional only is held for review.

3. 3. Check the expected payment

   Allowed amounts are compared with the contract or fee schedule for that payer, setting and component. Short pays go to an underpayment queue with their CARC and RARC codes attached.

4. 4. Move patient and secondary amounts

   Deductible, coinsurance and copay amounts move to the patient balance. When a secondary plan is on file, the rest is set up for the secondary claim and tracked by cardiology AR follow-up.

5. 5. Reconcile the deposit

   Posted totals are matched to bank deposits using the EFT trace number. An ERA without a deposit, or a deposit without an ERA, shows up on a list the same day.

6. 6. Route the exceptions

   Zero-pay lines, frequency denials on device checks and authorization denials on imaging go to the right queue. Each one carries its reason code and the original claim.

Cardiology Payment Posting Software vs. Generic Software

Who Uses It in a Cardiology Practice

• Payment poster: A short list of exceptions: files that do not balance, component mismatches, unit short pays and device period conflicts.
• Billing manager: Short-pay trends by payer and component. A plan that keeps paying office echoes at the hospital-read rate is easy to spot and take to contract talks.
• Practice CFO: Cash posted the way the bank reports it, with ERA and EFT matching behind each deposit and adjustments flowing to the general ledger.