Can Diagnostic imaging improve your cash flow for radiology billing?

February 06, 2017


Keeping medical billing and coding processes on track is a mighty big challenge. Stability and the income of the practice can be adversely affected by ineffective billing. Moreover, medical practices these days are routinely audited by both state and federal regulatory agencies which makes accurately documenting everything a pre-requisite, to support not just claim appeals but also proofs for overbilling which can be treated as fraud.

Diagnostic radiology encompasses a variety of services, including diagnostic radiology (plain film), diagnostic ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), diagnostic nuclear medicine, positron emission tomography (PET), and mammography

For Radiology Medical Billing, diagnostic imaging can be seen as bringing in cash revenues, if due diligence is paid to coding.

  1. Preauthorization for imaging provides a path to increasing revenues. It unlocks everything right from patient schedules to aiding in managing demand between inpatient, outpatient and emergency patients.
  2. Correct Modifiers & Codes: Applying the correct modifier to a procedure be it a technical (TC), professional (PC) or "global" service is essential to avoid claim denial. PC and TC do not apply to physician services that cannot be distinctly split into professional and technical components. However, Modifiers PC and TC may not be used with certain billing codes.
    • The TC of imaging services furnished to Medicare beneficiaries who are not patients of any hospital, and who receive services in a physician's office, a freestanding imaging or radiation oncology center, ambulatory surgical center (ASC), or other setting that is not part of a hospital, Medicare pays under the MPFSl. When imaging services are furnished in a leased hospital radiology billing department to a beneficiary who is neither an inpatient nor an outpatient of any hospital, both the PC and the TC of the services are payable under the MPFS by the carrier or A/B MAC.
    • Imaging services provided under arrangement are billed under Part A to Medicare Fiscal Intermediaries (FIs) and A/B MACs, using revenue codes. FIs and A/B MACs include the TC of imaging services for hospital inpatients in the Inpatient Prospective Payment System (IPPS) payment to hospitals, except that payment to Critical Access Hospitals (CAHs) for inpatients is made at 101 percent of reasonable cost. Carriers may not pay for the TC of imaging services furnished to hospital patients.
    • The PC of imaging services performed by physicians for hospital inpatients may be separately billed by the physician and paid by the carrier or A/B MAC. But for Outpatients in Hospitals Imaging services provided either directly or under arrangement are billed under Part B to Medicare FIs and A/B MACs, using revenue codes, HCPCS code, line item dates of service, units, and applicable HCPCS modifiers. Charges must be reported by HCPCS code.
    • Imaging services furnished to hospital outpatients are paid under the Outpatient Prospective Payment System (OPPS) to the hospital, except that payment to CAHs for outpatients is made at 101 percent of reasonable cost. Whereas, the PC of imaging services furnished to Critical Access Hospitals (CAH ) patients is made at 115 percent of the MPFS.
  3. Number of views used for CPT coding: It must be ensured that the coder has counted correctly the number of views and selected the corresponding CPT code and reported in the medical report. The number of views claimed must meet the basic requirements of the CPT® code reported.
  4. Radiopharmaceutical kit: Hospitals and privately-owned nuclear medicine and PET departments/offices should report the radiopharmaceutical kit separately utilizing the correct supply code(s)
  5. Documentation: Radiologists should note that all diagnostic ultrasound examinations require permanent image documentation. And the coding rules apply here.
  6. Ensure Compliance : Medicare requires that the technical component (TC) of advanced diagnostic imaging (ADI), for example, magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging, including positron emission tomography (PET), be billed only by those suppliers who are accredited by one of the CMS approved Accrediting Organizations for the ADI program.

Employing the above guidelines, radiologists utilizing diagnostic imaging, can definitely improve their cash flow and thus have a healthy and profitable Revenue Cycle Management (RCM) system.


Category : Best Billing and Coding Practices