Cardiology practice performance — quantified.
Independent cardiology groups face tighter MIPS windows, denser procedure-bundling rules, and more payer-specific reimbursement variability than almost any other specialty. We turn that complexity into a dollar-ranked opportunity list.
Why cardiology is different
MIPS weight is distinct
Cardiology’s quality measure set leans heavily on outcomes like heart failure readmission, anticoagulation for afib, and statin therapy for ischemic disease. Generic QPP benchmarks miss the levers that actually move your score.
Procedure bundling is dense
Rhythm monitoring (Holter, event, mobile cardiac telemetry), stress testing, and diagnostic imaging overlap with NCCI edits and modifier rules that change multiple times per year. Small misalignments compound fast at cardiology volumes.
Modifier usage matters
Modifier -25 (same-day E&M + procedure), -26 and TC (professional vs. technical split), and -59 (distinct procedural service) all appear on cardiology claims far more often than other specialties. Getting them right affects both revenue and audit exposure.
Payer mix volatility
Medicare Advantage penetration is cardiology-weighted in most markets. Commercial contract rates vary widely on high-volume CPTs (93000-series, 93306, 93880). A generic payer benchmark misses the contracts where you’re actually being underpaid.
What we audit for cardiology practices
E&M coding variance
Established-patient E&M distribution vs cardiology peers at 50th, 75th, and 90th percentiles. Per-provider breakdown so you see where the opportunity sits.
Procedure mix vs benchmarks
Rhythm, stress, imaging, and diagnostic procedure utilization benchmarked against specialty peers. Identifies under- and over-utilization patterns on a per-CPT basis.
NCCI + CCI bundling checks
Our engine catches the 443K+ pairs CMS flags as inherently bundled or requiring modifiers. Cardiology-specific pairs (e.g., stress + rest imaging bundling, rhythm monitoring overlap) are audited against your claims history.
MIPS/QPP scoring simulator
423 quality measures evaluated, with the cardiology-weighted subset highlighted. Projects payment adjustments and identifies the three highest-lift measures given your current data sources.
Ancillary utilization
EKG, Holter, event monitor, MCT, echocardiogram, and stress-test volumes compared to specialty peers. Flags under-billed ancillaries and over-ordered patterns that attract payer scrutiny.
Payer contract analysis
Per-CPT reimbursement against Medicare + regional commercial benchmarks. Identifies contracts where renegotiation is warranted with documented, code-level evidence.
ADA + security compliance
Patient-facing site scanned against WCAG 2.1 AA and the OCR 2022 tracking-pixel bulletin. Critical for cardiology practices with heavy patient education content and scheduling portals.
8-provider cardiology group — $3.2M identified
$3,235,312 in recoverable revenue and compliance risk across 69 findings. E&M coding variance, NCCI bundling exposure, MIPS score gap, modifier misalignment, ADA + tracking-pixel compliance. The detailed breakdown is in the case study.
Read the case studyOther specialties we cover
Primary care, radiology, gastroenterology, orthopedics, dermatology, pediatrics, and most other specialties. Our platform benchmarks against specialty-specific peers — not generic averages. Cardiology is our deepest specialty library; we’re expanding per-specialty content by demand.
Back to overviewWhat would your cardiology group find?
A 30-minute discovery call covers the cardiology-specific levers we see most often, walks through a live sample dashboard, and outlines what an engagement would look like for your practice.
Schedule a discovery call