How to Choose a Cardiology Billing Service in New York (2026 Checklist)

Cardiology practices in New York face a uniquely complex billing environment — multiple payer types (Medicare, Medicare Advantage, Medicaid MCOs, commercial), a high procedural mix (imaging, cath, EP, device monitoring), frequent prior authorizations, and strict documentation and coding requirements.

Choosing the right billing service can make the difference between timely reimbursement and repeated denials. Use this 2026 checklist as your decision framework when selecting or vetting a cardiology billing partner.

Pre-Selection: Define Your Practice Profile & Billing Needs

Before you start calling vendors, be clear about your practice’s specifics. This helps narrow the field to firms that will suit you best.

Ask yourself:

• What is our payer mix? (e.g., % Medicare, % Medicaid MCO, % commercial)
• What is our service volume and type? (office consults, echoes, stress tests, nuclear imaging, cath/PCI, EP, device monitoring)
• Do we perform device implantations or remote monitoring programs?
• How many providers are in our group — solo, small group, multi-provider?
• Do we need prior authorization management?
• What is the volume of denials and appeals we typically face?
• What are our internal staff capacity and expertise for billing, follow-up, coding, and audit support?

Having clarity on these helps you compare vendor capabilities more precisely.

The 2026 Cardiology Billing Service Vetting Checklist

When evaluating a billing service for cardiology in New York, go through this checklist. It’s designed to reflect the current payer, regulatory, and coding environment.

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🏥 CARDIOLOGY BILLING SERVICE CHECKLIST (2026)
New York Practices – Evaluation Guide
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✔ CARDIOLOGY-SPECIFIC CODING EXPERTISE
☐ Echo, stress, and nuclear cardiology coding
☐ Cath/PCI, EP studies, mapping & ablation
☐ Device checks (in-person & remote monitoring)
☐ Correct use of TC/26, 59/XS, RT/LT modifiers
☐ NCCI, MUE, and add-on code compliance

✔ NEW YORK PAYER EXPERIENCE
☐ Medicaid MCOs (Healthfirst, Fidelis, MetroPlus, etc.)
☐ Medicare & Medicare Advantage (payer-specific rules)
☐ Commercial payers (Aetna, UHC, BCBS, Emblem)
☐ Familiar with RBMs for imaging authorization

✔ PRIOR AUTHORIZATION & REFERRALS
☐ Ability to manage PA for imaging, cath, EP, devices
☐ Tracks expiration dates + authorization numbers
☐ Manages Medicaid MCO referral requirements

✔ DEVICE MONITORING WORKFLOWS
☐ Tracks 30-day / 90-day device monitoring intervals
☐ Bills 93224-93272, 93286-93296, 93298 correctly
☐ Handles loop recorder uploads & charge capture

✔ DOCUMENTATION & CLINICAL REVIEW
☐ Reads echo, stress, nuclear & cath reports
☐ Verifies medical necessity meets payer criteria
☐ Ensures signature + interpretation completeness
☐ Supports audit readiness (Medicare + MCO)

✔ DENIAL MANAGEMENT
☐ Dedicated denial + appeals workflow
☐ Denial categorization (PA, NCCI, coding, documentation)
☐ Timely resubmission + appeal creation
☐ Tracks payer-specific denial trends

✔ REPORTING & TRANSPARENCY
☐ Monthly AR aging by payer type
☐ Denial trend analysis (by CPT + payer)
☐ Unbilled encounters report
☐ Device monitoring due-date report
☐ Charge lag reporting

✔ TECHNOLOGY & EHR EXPERIENCE
☐ Works inside your EHR (Epic, Athena, eCW, NextGen, ModMed)
☐ No integration issues or file-upload delays
☐ Uses claim scrubbing tools with cardiology rules

✔ BILLING MODEL & CONTRACT
☐ Fair pricing model for your volume (percentage / FTE / hybrid)
☐ Clear expectations for clean-claim rate
☐ Exit clause + data migration clarity
☐ No hidden fees (PA, statements, add-ons)

✔ COMMUNICATION & SUPPORT
☐ Direct point of contact (not a rotating team)
☐ Quick turnaround on claim or denial issues
☐ Coordination with front desk + MA + provider
☐ Weekly or bi-weekly check-in calls available

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Use this checklist to compare cardiology billing vendors.
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What Questions to Ask Potential Vendors

When interviewing or vetting a candidate billing service, ask them:

1. Which cardiology CPT codes and service types do you handle routinely? (Echo/stress, nuclear, cath, PCI, EP, device, remote monitoring)
2. Do you have dedicated cardiology coders, or do you use general coders?
3. What is your clean claim rate (overall and specifically for cardiology procedures)?
4. How do you manage NCCI, MUE, add-on codes, and modifier compliance — manually or with a specialized scrubber?
5. How do you handle device monitoring (remote and in-person), billing, and interval tracking?
6. Do you support prior authorization and referral management for Medicaid MCOs, Medicare Advantage, and commercial plans?
7. Which New York payers do you have experience with? Any notable challenges handled recently?
8. What is your denial management workflow? How quickly do you respond and resubmit?
9. How often do you provide reports — AR aging, unbilled encounters, payer mix, denials by code, revenue by procedure type?
10. What billing model do you recommend for a practice like ours (size, volume, services)? And how flexible is it if volume changes?
11. How do you handle audit readiness and documentation retention, especially for cath/PCI, EP, device, and high-risk claims?
12. What is your communication protocol — who is our point of contact, how are complications handled, how are credentialing or payer issues escalated?

Choosing the Right Pricing & Contract Model

Your practice structure and volume should guide the pricing/contract model.

• Small practice with low procedural volume: per-claim or small %-collections model is often optimal
• Mid-size practice with mixed diagnostics + occasional procedures: hybrid model (percentage + add-on/procedure fees) balances cost and coverage
• Growing practice with increasing device monitoring, cath or EP volume: percentage-of-collections or FTE model ensures scalability and stable revenue cycle support
• Large group or multi-site practice: full-service RCM or hybrid model with transparency, reporting, and dedicated resources preferred

Ensure the contract includes clear metrics (clean-claim rate, denial targets, reporting frequency) and exit/transition terms.

Red Flags: When a Vendor May Not Be Right

Avoid vendors that:

• Have no prior cardiology-specific coding experience
• Use only general medical coders.
• Cannot show clean-claim or denial data for cardiology services
• Don’t support device monitoring or remote billing.
• Lack of prior authorization or payer-specific knowledge
• Provide opaque reporting or limited access to revenue-cycle data.
• Offer only one rigid pricing model regardless of volume or service complexity.
• Have poor communication workflows or delayed response times

Sample Decision Flow for 2026 — How to Choose

1. Define your practice profile & payer mix.
2. Shortlist vendors (3–5) that handle cardiology workflows and support New York payer types
3. Send them the checklist and questionnaire above.
4. Evaluate responses — prioritize CPT experience, clean-claim track record, denial management, device workflows, payer familiarity.
5. Request references from other NY cardiology practices (similar size/volume)
6. Run a short trial (30–60 days) to validate claim submission accuracy, denial rate, reporting, and communication responsiveness.
7. Review results, negotiate contract terms (pricing, metrics, transparency, exit clause)
8. Onboard with clear documentation workflows — ensure all echo, procedure, device, and interpretation reports are accessible to the billing team.

Why This 2026 Checklist Matters

• Payer policies and prior-authorization requirements evolve frequently.
• NCCI, MUE, and medical necessity expectations continue to tighten
• Device monitoring volume is rising — remote monitoring adds additional complexity.
• Medicaid MCOs and Medicare Advantage plans dominate many NY practices’ payer mix.
• Denial rates and audits remain among the top revenue risks for cardiology practices.

A billing service selected using this checklist maximizes the chance for clean claims, faster reimbursement, fewer denials, and sustainable revenue cycle management.

Many New York practices rely on experienced cardiology billing specialists — such as Global Tech Billing LLC — who meet these criteria and deliver reliable, compliant billing support tailored for cardiovascular practices.