New research has revealed that cardiac practices are losing hundreds of thousands of dollars a year due to widespread billing errors.
Los Angeles, California, September 24, 2026— DoctorMGT, a leading provider of medical billing, revenue cycle management, and credentialing services, today shared its findings from a comprehensive audit of more than 50,000 cardiology claims submitted throughout the country. Of all claims examined in the study, 60% had been identified by payers as missing or incomplete modifier documentation, an apparently minor issue that costs cardiac practices millions of dollars in Medicare and Medicaid reimbursements across the country.
The study included Medicare, commercial insurers, and workers’ compensation claims from independent practices, hospital-based programs, and ASCs from various payers. The findings tell a clear story: There are no rare edge cases in which modifier documentation is missing. They’re systemic.
“What we found was honestly alarming,” said the CEO of DoctorMGT. “Cardiology billing is incredibly complex, and there are multiple procedures performed in a single session, staged interventions, bilateral procedures, and each one requires a specific modifier to document what actually occurred during the procedure or cath lab session, and when it’s missing or not documented, that claim must be denied or held for review. These aren’t intentional fraud situations; these are workflow breakdowns.
The study identified three primary areas where modifier documentation fails:
Bilateral Procedure Documentation (38% of flagged claims):
Many practices failed to clearly document when procedures were performed on either side of the patient, leaving payers without the medical necessity documentation required for bilateral payment.
Staged Procedure Sequencing (28% of flagged claims):
Where more than one cardiac procedure occurred on different dates, documentation did not clearly define the staging, allowing payers to doubt the appropriateness of all procedures.
Component-Based Procedure Splits (22% of flagged claims):
In the case of complex interventions, the documentation would not convey which parts of the intervention were delivered. This prevented payers from confirming the proper selection of the codes and modifiers.
The financial impact is substantial. On average, each denied claim carries a value of $847 and takes 34 days to resolve. For a practice processing 500 claims per month. That adds up to hundreds of thousands of dollars tied up in unappealed or unresolved accounts receivable.
“But the frustration is that this is all preventable,” the CEO of DoctorMGT added. Practices need to focus on three key areas:
1) Training staff on the documentation requirements for modifiers.
2) Creating templates for the modifier to fill out at the time of charge
3) Conducting a compliance review process before they submit claims to payers.
The study also found that those practices that employed a structured documentation template had 73% fewer denials related to modifiers than those that used free text notes.
DoctorMGT is a medical billing company specializing in revenue cycle management, denial management, and cardiology billing. Its team of 150+ certified billers and coders brings deep billing expertise to every practice it works with. DoctorMGT offers full documentation support, staff training, and outsourced billing audits to help practices reduce claim denials and improve reimbursement accuracy. The company serves providers across specialties, including workers’ compensation and personal injury lien billing.
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