Lakeshore Cardiology
Key Results
1The Challenge
Cardiology billing is among the most complex in medicine, with procedure-specific modifiers, bundling rules, and payer-specific requirements that change frequently. Lakeshore Cardiology's previous system had no cardiology-specific coding intelligence, resulting in a 16% claim denial rate and over $200K in annual write-offs. The billing team of two spent most of their time on appeals rather than proactive revenue capture.
2The Solution
CareMetric AI's cardiology-specific claim scrubbing rules and procedure-based templates transformed the revenue cycle. The system understood cardiology bundling rules, modifier requirements for diagnostic vs. therapeutic procedures, and payer-specific pre-authorization needs. AI-powered coding suggestions ensured every encounter was coded to the highest appropriate specificity. The denial management workflow automated appeal generation with supporting documentation.
Our denial rate went from 16% to under 2%. We recovered nearly $190K in write-offs in the first year. The cardiology-specific coding intelligence is something no other EMR we evaluated could match.
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