COURSE DESCRIPTION
This foundational course is designed to equip cardiovascular (CV) professionals, operational staff and administrative team members with a comprehensive understanding of the CV billing lifecycle. Whether new to CV billing or seeking a refresher, this course delivers critical knowledge to ensure accurate billing, reduce denials and drive financial performance. Through four structured modules, learners will gain insight into both professional and facility billing processes, recognize common billing challenges, and learn how to track and act on key performance indicators.
The series was developed and presented by Nicole Knight, LPN,CPC,CCS-P, MedAxiom executive vice president of Revenue Cycle Solutions and Care Transformation Services, and Linda Gates-Striby CCS-P ACS-CA, MedAxiom revenue cycle consultant.
- Module 1: Professional Services Billing and Reimbursement Fundamentals
- Module 2: Hospital and Facility Billing Structures in Cardiovascular Care
- Module 3: Common Billing Pitfalls and Denials in CV Programs
- Module 4: Tracking KPIs and Driving Performance in the CV Revenue Cycle
COURSE GOALS
This curriculum is designed to aid CV providers in the proper billing process.
By the end of this course, participants will be able to:
- Understand the distinct reimbursement frameworks for professional and facility CV services.
- Identify and mitigate common billing errors and denial causes within CV programs.
- Apply best practices for claim submission and revenue integrity.
- Monitor and interpret key financial and operational metrics to support ongoing improvement and accountability.
This course is designed for a broad range of professionals supporting or interacting with the cardiovascular revenue cycle, including clinical and non-clinical team members.
For Practice Administrators and Operations Leaders
To support oversight of revenue cycle performance, compliance and workflow optimization.
For Billing and Coding Staff
To reinforce foundational knowledge specific to cardiovascular services and payer requirements.
For Front Desk, Scheduling and Pre-Authorization Teams
To understand the upstream impact of patient access functions on billing accuracy and reimbursement outcomes.
For Nursing and Clinical Staff Involved in Orders or Procedure Scheduling
To align clinical workflows with billing processes and reduce preventable denials.
For Revenue Integrity, Coding Billing and Compliance
To improve collaboration across departments and strengthen performance tracking and denial management.
No prior billing expertise is required, but familiarity with cardiovascular services and terminology is recommended for optimal comprehension.
REQUIRED TEXTS, MATERIALS, OR EQUIPMENT
Participants should have access to the following materials and tools to reference throughout: AMA CPT® Professional, ICD-10 CM Diagnosis Coding.
THE METHODOLOGY
Each lesson includes a 60-90-minute didactic video detailing the week’s focus.
This is a pass/fail course based on completing the material. Students must participate in the final course evaluation feedback survey to receive a certificate of completion.
COURSE GRADING
Statement of Grading Approach or Philosophy:
Each enrollee will have up to 12 months to complete the course material. Users must participate in the final course evaluation feedback survey to receive the certificate of completion.
Weekly Breakdown of Hours:
- Week 1: 1.5
- Week 2: 1.5
- Week 3: .5
- Week 4: .5
SCHEDULE OF TOPICS AND LEARNING OBJECTIVES
Disclaimer: The instructors reserve the right to make modifications to this course material as needed.
Preliminary Schedule of Topics, Learning Objectives, Readings and Quizzes
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MODULE
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TOPIC/LEARNING OBJECTIVES
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1
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Topic: Professional Services Billing and Reimbursement Fundamentals
Learning Objectives:
- Understand how physician and advanced practice provider services are billed, including evaluation and management (E/M) coding, procedural billing, modifiers and the Medicare Physician Fee Schedule (MPFS). Learn about requirements, payer rules, and common pitfalls that affect payment for CV services.
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2
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Topic: Hospital and Facility Billing Structures in Cardiovascular Care
Learning Objectives:
- Explore the structure of hospital billing for inpatient and outpatient cardiovascular services, including Medicare Severity Diagnosis Related Groups (MS-DRGs) and Ambulatory Payment Classification (APC) methodologies, revenue codes, and the relationship between documentation, coding and reimbursement.
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3
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Topic: Common Billing Pitfalls and Denials in CV Programs
Learning Objectives:
- Review the most frequent billing errors and denial reasons specific to cardiology services—such as authorization issues, charge capture gaps and coding discrepancies. Participants will learn strategies for prevention, root cause analysis,and cross-functional workflow improvement.
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4
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Topic: Tracking KPIs and Driving Performance in the CV Revenue Cycle
Learning Objectives:
- Learn how to track and interpret key performance indicators (KPIs) such as denial rates, days in A/R, charge lag and first pass yield. Understand how to turn data into action by establishing accountability structures, identifying trends and implementing timely interventions.
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