How Complicated Radiology Billing Needs End to End Revenue Management?

August 11, 2017


Radiology billing and coding procedures is complex and differ from other specialties of medicine. Reducing reimbursements, mounting infrastructure costs and changes in payer mix tend to create a challenge for radiology billing. Further, billing complexities are especially high for radiologists as their processes are complex and cumbersome due to ever-changing regulations.

Radiology billing hence needs end to end revenue management. Here's how:

1. Explain clearly: The patient must be aware of their debts, especially in the case of radiology (radiology is more complex due to added documentation and other tests such as X-ray, MRI, and PET scans etc.). As the specialty has more paper work and less face time, it's imperative to make clear the financial obligations to the patient and focus more on validation and notification.

2. Modifiers: Incorrect modifiers (either a wrong one added or a missing one) can be a great reason for loss of reimbursements in radiology.

3. Medicare: In Medicare, if the service is not covered, an ABN must be give to the patient as it covers the facility technical component and the professional component fee. Radiologists must receive this copy of the ABN; also beneficial for fewer patient write-offs.

4. Audits: With Recovery Audit Contractors (RACs) and Comprehensive Error Rate Testing (CERTs) in place, radiologists need to be aware of the verbiage used to describe exams. This certainly eliminates the need for appeals, clean audits, quicker claims and a clean claim rate in the long run.

5. Templates: Templates must be created by radiologists for apt documentation; especially in cases where the equipment changes from analog to digital mammography, the templates must change too. These templates must be checked with the CPT on a yearly basis. Furthermore, if there is a change in protocol or technique, the templates must change.

6. Documentation: Accurate and a comprehensive documentation aids in a smooth billing and coding process, furthering clean claims and reimbursements. This helps in eliminating referral errors as the radiology medical billing and coding process must employ the same study as per the referring physician. This also enables accounting of all revenues, capturing of all charges and ensures the data is of highest quality. It is also advised to incorporate system scrub codes and Dx rules in the system for an accurate claims submission process.

7. Coders: It is imperative that physicians and/or radiologists are in constant contact with the coders; as coders can then with ease confirm the procedures and their accurate codes. This also tends to decrease mistakes and increase the chances of correct claim filing. Coders must use the apt diagnosis code and the CPT Service codes.

8. Database: As with other medical specialties, the radiology department too must maintain a database of the medical history and tests conducted of each patient (to avoid errors in billing and payments).

9. Denial rates: Around 40% of denials is chiefly due to eligibility errors. It is advisable to meet the billers and coders and monitor the reasons of denials and its sources.

10. Payments: Get the patients to pay upfront before the radiology service is scheduled or set up automated payment plans before the radiology services are rendered in order to maximize reimbursements.

11. Outsourcing: Radiology billing is probably one such field where outsourcing may just be a better option to have claims quickly billed, filed, make quick appeals in necessary cases along with reporting and reimbursements received. Accounts Receivables (A/R): The outsourcing firm must analyze all the account information, execute denial and prevention procedures, include a regular review schedule, comprise reimbursement tracking tools, evaluate year-to-date totals with the previous years, and follow up vigorously with unpaid claims more than 60 days old.

The above mentioned steps and a comprehensive revenue cycle management consisting of efficient and optimized processes such as appointment scheduling, filing claims and AR follow up can augment the reimbursement process, along with achieving sustained and incremental revenue growth.


Category : Outsource Medical Billing