A cardiology practice can be fully booked every single day and still be quietly losing money. The warning sign isn’t in the schedule. It’s in the aging report, where claims sit unpaid for 60, 90, or even 120 days while the practice keeps covering payroll and overhead out of pocket.
Accounts Receivable days, often shortened to A/R days, is one of the most important financial metrics any cardiology practice can track. It measures exactly how long it takes to turn delivered care into actual cash in the bank. When that number creeps upward, cash flow tightens, profitability erodes, and the entire practice becomes financially unstable, even if patient volume is strong.
Cardiology carries more of this risk than most specialties. Between high value procedures, heavy prior authorization requirements, and constant payer scrutiny, cardiology claims are simply harder to get paid quickly than a routine office visit. We’ve seen this play out directly with cardiology practices in California working through a wave of claim denials, where the fix rarely came down to one single error. General billing knowledge, however capable, often isn’t enough to keep A/R days under control in this specialty.
This guide breaks down exactly what A/R days measure, why cardiology practices consistently run higher than other specialties, what a specialized cardiology billing partner actually does differently, and a detailed, transparent look at the companies and platforms cardiology practices commonly evaluate. This list reflects publicly available information, service offerings, and specialization. It is not a universal ranking, and The Medicator’s is featured first as our own recommended solution, clearly labeled as such.
What Are A/R Days in Medical Billing?
Definition
Days in Accounts Receivable, also called Days Sales Outstanding, measures the average number of days it takes a practice to collect payment after a service has been billed. It’s calculated by dividing total outstanding accounts receivable by average daily charges over a set period, typically the trailing 90 days.
A/R days is one of the most closely watched Revenue Cycle Management KPIs because it directly reflects how efficiently claims move from submission to payment, a concept we break down further in our complete guide to accounts receivable in medical billing. A low number means your billing process is working. A rising number means something in that pipeline, whether it’s coding, documentation, payer follow up, or authorization, is creating friction.
The impact on practice financial health is direct and immediate. Every day added to your A/R cycle is another day that revenue you’ve already earned sits unavailable, unable to cover payroll, supplies, or reinvestment in the practice.
General benchmarks exist, but acceptable ranges genuinely vary by specialty, payer mix, and practice size. According to the Medical Group Management Association’s accounts receivable benchmarking data, most well performing practices target Days in A/R under 40, with top performing groups operating closer to 30 to 35 days. Cardiology practices, given their procedural complexity, often run somewhat higher than that general benchmark even when billing is being handled well.
Why Cardiology Practices Often Have Higher A/R Days
Several factors specific to cardiovascular medicine push A/R days upward compared to primary care and many other specialties.
Complex cardiovascular procedures, from cardiac catheterization to electrophysiology studies, involve layered coding and documentation requirements that take longer to prepare correctly and longer for payers to review. High value claims naturally attract more payer scrutiny, since the financial stakes of a coding error are higher on a five figure procedure than a routine visit.
Prior authorization delays are common for advanced imaging, catheterization, and device procedures, and treatment often can’t begin, let alone be billed, until approval comes through. Medical necessity reviews are frequent for elective cardiac procedures, adding another layer of payer evaluation before payment is released.
Multiple diagnostic tests performed in the same visit, such as an echocardiogram alongside an ECG, require correct sequencing and bundling logic to avoid delays, a topic we explore in more depth in our piece on hidden reasons behind claim denials even with accurate coding. Device and implant billing for pacemakers and defibrillators involves detailed tracking that must align precisely across the operative note, the HCPCS code, and the claim, while also staying current with CMS National Correct Coding Initiative edits that govern which services can be billed together. Medicare documentation requirements for cardiac procedures are notably strict, and any gap triggers additional review. All of this contributes to frequent claim denials and a heavier appeals workload than most other specialties carry, each of which adds directly to A/R days.
How Cardiology Billing Impacts Revenue Cycle Performance
A/R days aren’t determined by one step in the billing process. They’re the cumulative result of every stage in the revenue cycle working correctly, or not.
The complete workflow runs through patient registration, insurance eligibility verification, benefits verification, prior authorization, clinical documentation, CPT coding, ICD-10-CM coding, HCPCS coding where applicable, modifier assignment, claim scrubbing, claim submission, payer adjudication, payment posting, accounts receivable follow up, denial management, appeals, and finally payment collection.
A breakdown at any single stage adds days, sometimes weeks, to the overall cycle. Missing an authorization at the front end delays the entire claim regardless of how accurate the coding is later. A coding error caught only after submission means the claim bounces back for correction and resubmission, adding another full adjudication cycle. This is exactly why A/R days function as such a reliable proxy for overall billing health. It’s a single number that reflects the performance of the entire chain.
What Does a Cardiology Billing Company Do?
A dedicated cardiology billing company manages this entire chain with specialty specific expertise, including insurance eligibility verification, benefits verification, prior authorization, cardiology specific coding, charge capture, claim scrubbing, claim submission, payment posting, denial management, appeals, accounts receivable follow up, and full Revenue Cycle Management optimization.
The difference between general billing support and true cardiology specialization usually shows up first in coding accuracy and prior authorization handling, since both require detailed familiarity with cardiovascular procedures, device coding, and payer specific documentation expectations that a generalist team often hasn’t built.
How Specialized Billing Companies Reduce A/R Days
Specialized cardiology billing partners bring down A/R days through faster claim submission, higher clean claim rates on first submission, better coding accuracy specific to cardiovascular procedures, and proactive denial prevention rather than reactive cleanup.
They also tend to post payments faster once reimbursement arrives, follow up on aging accounts receivable proactively rather than waiting for a monthly review, maintain stronger payer communication built on specialty specific relationships, manage appeals more effectively when claims are denied, and provide better reporting and analytics that make it easy to see exactly where the cycle is slowing down. As we’ve discussed in our breakdown of the most common cardiology billing mistakes, many of the errors driving up A/R days are entirely preventable with the right coding and documentation discipline from the start.
How We Evaluated Cardiology Billing Companies
Choosing a billing partner deserves real scrutiny, not a decision based on price alone. Our evaluation weighed cardiology specific specialization, the depth of Revenue Cycle Management capabilities offered, coding expertise specific to cardiovascular procedures, the strength of the A/R follow up process, denial management approach, technology integration with common EHR and practice management systems, quality of reporting and dashboards, compliance program strength, responsiveness of customer support, and pricing transparency.
No single provider is the right fit for every practice. The right choice depends heavily on your practice’s size, existing technology, and how much of the billing process you want to retain control over internally.
Cardiology Billing Companies That Help Reduce A/R Days
The Medicators is featured first as our own recommended solution, given our specialization in cardiology billing, followed by other established platforms and billing companies in this space, presented alphabetically rather than ranked.
The Medicators (Featured Recommendation)
The Medicators specializes in cardiology billing specifically, built around dedicated A/R follow up rather than treating aging claims as an afterthought.
Cardiology expertise: Our coding team works specifically with cardiovascular procedures, including echocardiography, cardiac catheterization, electrophysiology, and device implantation billing.
Core services: Certified coding specialists handle accurate ICD-10-CM, CPT, and HCPCS coding, backed by dedicated prior authorization support, advanced claim scrubbing, proactive denial management, structured appeals, and full Revenue Cycle Management.
Best for: Cardiology practices of any size looking for a genuine specialty partner rather than a generalist billing service layered on top of practice management software.
Strengths: Deep cardiology coding knowledge, dedicated A/R follow up specialists who treat aging claims as active recoverable revenue rather than a monthly report, and transparent analytics that show exactly where your A/R stands at any point.
Potential considerations: As a specialized billing service rather than an all in one software platform, practices already committed to a specific EHR should confirm integration compatibility during onboarding.
CareCloud
Overview: CareCloud offers cloud based practice management, EHR, and revenue cycle management services across multiple specialties, including cardiology.
Cardiology expertise: Supported through its general RCM service offerings rather than a cardiology exclusive product line.
Core services: Practice management software, EHR, billing services, and analytics dashboards.
Best for: Small to mid sized multi specialty groups wanting an all in one software and RCM combination.
Strengths: Established, publicly traded platform with broad technology coverage across clinical and financial workflows.
Potential considerations: As a multi specialty platform, cardiology specific coding depth may vary depending on the account team and service tier selected.
AdvancedMD
Overview: AdvancedMD provides cloud based practice management, EHR, and medical billing software used across a wide range of specialties.
Cardiology expertise: Available through its billing software and optional outsourced RCM services, though not marketed as cardiology exclusive.
Core services: Practice management, telehealth, patient engagement tools, and billing software with optional outsourced billing support.
Best for: Independent practices and small to mid sized groups wanting flexible software.
Strengths: Long standing presence in the practice management software market with broad feature coverage.
Potential considerations: Practices wanting fully outsourced cardiology specific A/R management, rather than software plus general billing support, should confirm exactly what’s included in their specific tier.
Athenahealth
Overview: Athenahealth provides cloud based EHR, practice management, and revenue cycle management services to a broad range of specialties, including cardiology.
Cardiology expertise: Supported through its broader RCM offering rather than a cardiology exclusive product.
Core services: EHR, practice management, medical billing, and population health tools.
Best for: Small practices through larger multi specialty health systems.
Strengths: Established, large scale platform with extensive payer connectivity and a long track record in the RCM space.
Potential considerations: As a large, multi specialty platform, the depth of cardiology specific A/R follow up can vary and is worth confirming directly.
DrChrono
Overview: DrChrono offers a cloud based EHR and practice management platform with integrated billing tools, used across multiple specialties.
Cardiology expertise: Available through general billing functionality rather than a dedicated cardiology focus.
Core services: EHR, practice management, medical billing, and patient engagement tools.
Best for: Small to mid sized independent practices.
Strengths: Flexible, customizable platform with strong mobile charting tools.
Potential considerations: Cardiology practices with complex procedural billing needs may want to pair the platform with dedicated specialty coding support.
eClinicalWorks
Overview: eClinicalWorks offers EHR, practice management, and billing solutions used across numerous specialties, including cardiology.
Cardiology expertise: Available through general billing services rather than a dedicated cardiology product line.
Core services: EHR, practice management software, patient engagement tools, and billing support.
Best for: Small to large practices and health systems.
Strengths: Broad specialty coverage and a large, established customer base.
Potential considerations: Cardiology practices should confirm the specific coding expertise available for procedural and device billing within their service tier.
NextGen Healthcare
Overview: NextGen Healthcare provides EHR, practice management, and revenue cycle management solutions across a range of specialties and practice sizes.
Cardiology expertise: Available through its broader RCM service line rather than a dedicated cardiology focus.
Core services: EHR, practice management, billing services, and interoperability tools.
Best for: Small practices through larger multi location and multi specialty groups.
Strengths: Established platform with strong interoperability and reporting capabilities.
Potential considerations: As with other multi specialty platforms, confirming the specific depth of cardiology coding and A/R expertise available is worth doing during evaluation.
CureMD
Overview: CureMD provides EHR, practice management, and billing services across a range of medical specialties.
Cardiology expertise: Available through its broader billing service offering.
Core services: EHR, practice management, medical billing, and patient portal tools.
Best for: Small to mid sized independent practices.
Strengths: Integrated clinical and billing platform with a straightforward implementation process.
Potential considerations: Practices with high procedural volume should confirm the depth of cardiology specific coding expertise available.
Kareo / Tebra
Overview: Kareo, now operating under the Tebra brand following its 2021 merger with PatientPop, offers cloud based EHR, practice management, and billing tools built for independent practices.
Cardiology expertise: Supported through general billing functionality within the platform rather than a cardiology exclusive focus.
Core services: EHR, practice management, billing and payments, and patient engagement and marketing tools.
Best for: Independent and small to mid sized practices.
Strengths: Combines clinical, billing, and patient acquisition tools in a single platform.
Potential considerations: Practices needing deep cardiology specific A/R and coding support may want to confirm whether that expertise is available directly or through a third party billing partner layered on top.
PracticeSuite
Overview: PracticeSuite offers cloud based medical billing, practice management, and EHR software supporting a large number of billing and clinical specialties, used by both individual practices and third party billing companies.
Cardiology expertise: Supported through its general billing and RCM tools, covering cardiology among a wide range of specialties rather than as an exclusive focus.
Core services: Practice management, billing software with denial management and multi client dashboards, EHR, and reporting tools.
Best for: Independent practices and billing companies wanting a single platform to manage multiple client accounts.
Strengths: Deep reporting capabilities and a platform built specifically to support billing companies managing multiple practices at once.
Potential considerations: As primarily a software platform, practices wanting fully outsourced cardiology specific A/R follow up will need to pair it with dedicated billing staff or a billing partner.
Side by Side Comparison Table
| Company | Cardiology Focus | A/R Management | Coding Support | Denial Management | Reporting | Best For |
| The Medicators | Specialized | Dedicated follow up specialists | Cardiology certified coders | Proactive, dedicated | Transparent, detailed | Practices wanting a true cardiology billing specialist |
| CareCloud | General multi specialty | Available | Standard multi specialty | Available | Analytics dashboards | Practices wanting an all in one software plus RCM option |
| AdvancedMD | General multi specialty | Optional add on | Standard multi specialty | Available | Standard reporting | Independent practices wanting flexible software |
| Athenahealth | General multi specialty | Available | Standard multi specialty | Available | Extensive analytics | Larger practices and health systems |
| DrChrono | General multi specialty | Limited | Standard multi specialty | Available | Standard reporting | Small practices wanting mobile first charting |
| eClinicalWorks | General multi specialty | Available | Standard multi specialty | Available | Standard reporting | Practices of varying sizes wanting broad specialty coverage |
| NextGen Healthcare | General multi specialty | Available | Standard multi specialty | Available | Strong interoperability reporting | Multi location and multi specialty groups |
| CureMD | General multi specialty | Available | Standard multi specialty | Available | Standard reporting | Small to mid sized independent practices |
| Kareo / Tebra | General multi specialty | Available | Standard multi specialty | Available | Standard reporting | Independent practices wanting billing plus marketing tools |
| PracticeSuite | General multi specialty | Software based, multi client dashboards | Standard multi specialty | Available | Strong billing company reporting | Billing companies managing multiple client accounts |
Common Causes of High A/R Days in Cardiology Practices
Understanding the root causes behind rising A/R is the first step toward fixing it. It’s a question we hear constantly in different forms, including from practices simply wondering why insurance payments are taking so long to arrive. The most frequent drivers include insurance eligibility issues discovered after the visit rather than before it, prior authorization delays that push back treatment and billing simultaneously, coding errors specific to cardiovascular procedures, documentation deficiencies that undermine medical necessity, medical necessity denials tied to elective procedures, modifier errors on procedures requiring professional and technical component splits, payment posting delays that make the A/R report look worse than it actually is, a growing appeals backlog, poor internal follow up workflows on aging claims, and patient balance delays tied to high deductible health plans.
High-Risk Cardiology Services That Commonly Increase A/R Days
Certain cardiology services carry a disproportionate share of A/R risk, largely because they require additional documentation or trigger closer payer review.
Evaluation and Management (E/M) visits billed alongside procedures require careful modifier use to avoid bundling denials. Echocardiograms carry coding complexity tied to complete versus limited studies and Doppler components, an issue closely related to the scrubbing and denial patterns we cover in our broader claims guide.
Electrocardiograms (ECGs/EKGs) are frequently bundled with other same day services under NCCI edits. Stress tests and Holter monitoring both require precise documentation of medical necessity, particularly for Medicare patients. Cardiac catheterization and coronary angiography involve some of the most detailed procedural coding in cardiology, where our guide to left heart catheterization CPT coding breaks down exactly where these claims commonly go wrong.
Pacemaker procedures and Implantable Cardioverter Defibrillator (ICD) procedures require device specific tracking that must align precisely across documentation and coding. Percutaneous Coronary Intervention (PCI) carries some of the highest reimbursement values in cardiology and, correspondingly, some of the closest payer scrutiny.
Technology That Helps Reduce A/R Days
Modern cardiology billing increasingly depends on Electronic Health Records that integrate cleanly with billing workflows, cardiology specific practice management software, full Revenue Cycle Management platforms, dedicated claim scrubbing software, AI assisted coding tools that flag potential mismatches before submission, denial analytics that surface patterns across claim volume, and Electronic Prior Authorization systems that speed up approval timelines for procedures and advanced imaging.
Medicare, Medicaid, and Commercial Insurance Considerations
Medicare
Medicare coverage for cardiology services is shaped by detailed documentation expectations and medical necessity standards, particularly for procedures like catheterization and device implantation, where CMS scrutiny has increased in recent years. Reimbursement rates for these procedures can be confirmed directly through the CMS Physician Fee Schedule Look-Up Tool, and clinical guidance on appropriate use criteria is published by professional bodies such as the American College of Cardiology.
Medicaid
Medicaid rules vary significantly by state, and authorization requirements for cardiac procedures can differ substantially depending on which state program is billed.
Commercial Insurance
Commercial payer contracts and coverage policies for cardiology procedures vary widely, and appeal timelines differ by payer, which makes tracking payer specific deadlines essential to avoid losing the right to appeal a denial altogether.
Key Performance Indicators (KPIs) to Evaluate Billing Companies
Ask any prospective billing partner to share their actual, current performance on these metrics rather than general assurances about quality.
| KPI | Why It Matters |
| Days in Accounts Receivable (A/R) | Measures reimbursement speed directly |
| Clean Claim Rate | Indicates overall billing accuracy |
| First-Pass Claim Acceptance Rate | Tracks the quality of initial claim submissions |
| Claim Denial Rate | Measures overall billing effectiveness |
| Net Collection Rate | Reflects overall revenue performance |
| Appeal Success Rate | Measures how effectively denied claims are recovered |
Questions to Ask Before Hiring a Cardiology Billing Company
Bring these questions to every conversation with a prospective billing partner:
- Do you specialize in cardiology billing specifically?
- How exactly do you reduce A/R days for practices like mine?
- What is your denial management process, step by step?
- How often do you follow up on unpaid claims?
- What reports do you provide, and how frequently?
- Do you support my specific EHR system?
- How do you handle prior authorizations for cardiac procedures?
- What coding certifications does your team hold?
- What pricing model do you use, and is it fully transparent?
- What onboarding process should I expect, and how long does it take?
Common Mistakes Practices Make When Choosing a Billing Company
Practices frequently choose a billing partner based solely on cost, without weighing what a higher denial rate or slower A/R recovery will actually cost down the line. Other common mistakes include ignoring genuine cardiology specific expertise, overlooking the strength of a company’s A/R management capabilities specifically, not reviewing reporting quality before signing a contract, failing to evaluate technology compatibility with existing systems, ignoring compliance processes, and not checking references or case studies from similar cardiology practices.
Why The Medicators Stands Out for Cardiology Billing
Every evaluation criterion in this guide points toward the same conclusion: reducing A/R days in cardiology requires genuine specialization, not a general multi specialty approach applied broadly.
The Medicators brings a specialized cardiology billing team built around accurate CPT, ICD-10-CM, and HCPCS coding for cardiovascular procedures specifically. Every claim benefits from dedicated A/R follow up specialists who treat aging claims as active, recoverable revenue, backed by advanced claim scrubbing and dedicated prior authorization management for procedures and advanced imaging.
When denials do occur, our denial prevention and appeals process works to recover revenue quickly, supported by full Revenue Cycle Management optimization and transparent analytics and reporting that show exactly where your A/R stands. Personalized client support means you’re working with a team that understands cardiology billing specifically, not a generalist account manager juggling dozens of unrelated specialties.
If your cardiology practice is ready to move from generalist billing support to true specialty expertise, our cardiology billing services are built specifically for that transition, and our dedicated A/R management services are designed to bring aging claims back under control quickly.
Conclusion
Reducing A/R days requires more than persistent follow up calls to payers. It depends on accurate coding, complete documentation, efficient claim submission, proactive denial management, and continuous performance monitoring across the entire revenue cycle.
Cardiology practices should evaluate billing partners based on specialty expertise, measurable results, technology, and transparency rather than cost alone. The cheapest option often becomes the most expensive once rising A/R days and denial rework are factored into the real cost of care.
With dedicated A/R management, cardiology specific coding expertise, and comprehensive Revenue Cycle Management services, The Medicators can help your practice improve cash flow and achieve faster insurance reimbursements. Before anything else, it’s worth asking yourself how healthy your revenue cycle actually is today. If aging claims are quietly draining revenue from your cardiology practice, contact The Medicators to see exactly where your A/R days stand and what’s driving them.
Frequently Asked Questions
What are A/R days in medical billing?
A/R days, or Days in Accounts Receivable, measure the average number of days it takes a practice to collect payment after a service has been billed, calculated by dividing total outstanding accounts receivable by average daily charges.
What is considered a healthy A/R benchmark?
According to MGMA benchmarking data, most well performing practices target Days in A/R under 40, with top performing groups operating closer to 30 to 35 days, though cardiology practices often run somewhat higher given their procedural complexity.
Why are cardiology A/R days often higher than other specialties?
Cardiology involves complex, high value procedures, frequent prior authorization requirements, strict Medicare documentation standards, and device specific billing, all of which add time and review steps to the reimbursement process.
How can a billing company reduce A/R days?
Specialized billing companies reduce A/R days through faster and more accurate claim submission, proactive denial prevention, dedicated follow up on aging claims, and stronger payer communication built on cardiology specific expertise.
How do I choose the right billing company?
Evaluate cardiology specific experience, A/R management capabilities, coding certifications, denial management approach, technology compatibility, and pricing transparency rather than cost alone.
Which KPIs should I monitor?
Days in Accounts Receivable, clean claim rate, first-pass claim acceptance rate, claim denial rate, net collection rate, and appeal success rate are the most important metrics to track.
How does claim scrubbing improve collections?
Claim scrubbing checks claims for errors before submission, catching many of the issues that would otherwise cause a denial or delay, which directly improves both clean claim rate and A/R days.
Can outsourcing reduce claim denials?
Yes. Specialized billing partners bring cardiology specific coding accuracy and proactive documentation review that typically reduce denial rates compared to general in house billing processes.
Why choose The Medicators for cardiology billing?
The Medicators combines cardiology specific coding expertise, dedicated A/R follow up specialists, and transparent reporting built specifically around the complexity of cardiovascular billing, rather than treating cardiology as one specialty among many.
