March 19, 2015
The key for timely settlement of claims lies in a comprehensive billing and coding process. It is crucial to ensure a steady revenue generation for a Radiology practice. All the billing and coding practices need to be kept in order so that the claims are processed without any glitches. Moreover, the medical and support staff need to be aware of the correct coding and billing procedures. It is a known fact that billing and coding can take up a lot of time and might rob the radiologist from performing his actual duty. Also, radiologists might not be trained to handle the exhaustive billing and coding process.
In fact, there could be a situation where radiologists might feel that they are doing everything correctly, but still the claims keep on getting denied. Furthermore, they might harbor a notion that payers are coming up with different and unheard type of denials everytime a claim is submitted. Hence, they might even think that although they have a proper billing and coding process, their claims are not getting accepted and are tricked into denied payments. Honestly speaking, insurance companies have an economic incentive in denying claims so it is practically impossible to bring down the denial rate to zero. However, a strong strategy of denial prevention and follow-up can help in improving the situation.
The Radiology market share which was at $866 million in 2012 is expected to grow at a rate of over three percent and reach $1,045 million by 2018
These are a few steps that radiologists can take to reduce the claim settlement delays:
This point is of utmost importance. To improve reimbursements, all denials should be reviewed within 72 hours and acted upon within seven days. The old method of reprinting the denied claim and sending it back to the payer with a rubber stamp stating appeal will not help. The claims need to get corrected with measures like adding the requested information and resending them to the insurance companies quickly. This can improve the claim settlement process by at least 80%.
Learn from your follies:
A long term improvement plan can happen only if one is ready to learn from their mistakes. Just by correcting the denied claims and sending it back will not help. One needs to analyze why the claim got rejected. For instance, one might find a recurring error in capturing the demographic information and thus it will help you to realize the common problem area with the front-desk registration staff or registration process.
It is vital that the billing and coding team use the updated codes of the new coding standard ICD-10. This will ensure correct billing and timely payments.
The coding differs as per the level of illness of the patients. They need to ensure that correct coding is done as per the level of illness. All patients cannot be at the same level of illness at the same time; some may be worse than the others.
It would be a good move to outsource these jobs to MedicalBillersandCoders.com; they can provide specialized billing and coding services for your radiology practice. Their team of experts helps providers of over 40 medical specialties to reduce claim settlement days and give them a competitive edge over competitors.
Best Billing and Coding Practices