A 22% denial rate on electrophysiology and stress-test claims was costing the practice over $185,000 in recovered revenue annually — and an overwhelmed in-house billing team had no bandwidth to work the aging AR.
EP study claims routinely denied due to missing pre-authorization documentation and incorrect modifier stacking
Nuclear stress-test bundles frequently unbundled incorrectly by payers, with no systematic appeal process
In-house billing staff averaged 47 days to rework denied claims — most past timely filing limits
AR over 120 days had grown to 31% of total outstanding, representing $312,000 in at-risk revenue
The Medtransic Solution
Medtransic deployed a dedicated cardiology billing team with AAPC-certified coders specializing in interventional and diagnostic cardiology. Within 30 days, a full AR audit identified $128,000 in recoverable claims and established payer-specific appeal templates for the five highest-denial payer combinations.
Payer-specific authorization matrix built for all 11 active payer contracts — automated alerts triggered for high-denial CPT codes
Correct modifier sequencing protocols implemented for 93000-series and EP codes, validated against each payer's LCD
Retroactive appeal campaign worked all denials within 180-day timely filing window — $128K recovered in 90 days
Monthly payer performance report introduced, enabling contract renegotiation conversations with two underperforming payers
Measurable Results
Denial rate dropped from 22% to 3.8% within six months
$128,000 recovered through retroactive appeal campaign in first 90 days
Net revenue increased 34% year-over-year after full transition
AR over 120 days reduced from 31% to under 4% of total outstanding
Two payer contracts renegotiated for improved reimbursement rates
Client Testimonial
We had convinced ourselves that a 20%+ denial rate was just part of cardiology billing. Medtransic showed us that wasn't true — it was fixable. The difference in our collections within the first quarter was significant enough to fund a full-time clinical hire.
Practice at a Glance
Specialty: Cardiology
Location: Mid-Atlantic Region
Practice Size: 4 cardiologists, 2 NPs
Timeline to First Results: 90 Days to First Results
Engagement Year: 2024
Client name and identifying details anonymized per HIPAA compliance guidelines and client request. All metrics and outcomes are verified against actual billing records from this engagement.