Radiology is a high-volume field; consequently, medical billing and coding of this specialty is nothing less than critical. Radiologists have been facing declining reimbursements due to the ever changing health care rules, increased costs of equipment, private payers adopting Medicare rates, and the consolidation of other interventional radiology and CT codes. Again, non-physician professionals, increased competition and an unrealistic focus on productivity is leading to declining reimbursements in radiology. Adequate documentation, apt charge insurers, best practices, regular auditing and documentation of all procedures and billing costs must be attained to enhance the radiology revenue cycle management process.
Some ways to increase reimbursements for radiologists are:
Radiology coding inconsistencies are very common. Many a times, the technician forgets to capture charges, update procedures or provide supplies' details. Again, the radiology billing department may not have the relevant documented details of the procedures. This causes costs reduction, greater denials, compliance issues and inefficiencies. Hence the need is for concise and complete documentation for apt radiology coding and accurate reimbursements. Also, some important aspects to be kept in mind are: Do not list exam titles but list clinical indications separately in the finding section or impression. Exam titles must consist of anatomical site, views, and usage of contrasts; exams must be laconic, and terms and phrases must be void of being filled with unclear or unfamiliar terms. Also, the physician must have knowledge of CPT codes and maintain adequate documentation. Some common documentation includes: "CTA ordered, but 3D not documented; Doppler ordered, but spectral analysis not documented; inconsistent number of views between the radiologist's interpretation and the report header; no valid diagnosis, need for reportable signs or symptoms; appropriate body parts are not properly enumerated, etc." A coder workflow must include regular inquiries, thereby aiding accurate coding and data integrity.
A regular workflow must be established between the radiology coder and physician. This can be easily done by a well-defined electronic query system (with automated reminders) to promote flexibility, clarity, transparency, information acquisition, for specificity or to determine the importance of certain procedures, pathological or radiological findings from the physician. Perform internal audits on queries and structure it according to protocols.
Partnership with a revenue cycle management company can work wonders for your radiology billing and coding. They are experts in reviewing documents, catch errors before submission, verify and submit clean claims, and follow compliances.
All coders must be certified, and credentialed after two years post apprenticeship. This way they stay updated and are aware of the latest codes and guidelines. Be it in-house or outsourced, continued education of coders is a must.
If regular audits and compliance programs are in place, apt radiology coding procedures will always be followed. Audits will encourage faster, cleaner and increased reimbursements (also due to lesser rejections/denials). Ensure regular monitoring of charge capture and its strategies.
The documentation given by radiologists must be apt and precise for the radiology billing professionals to understand and apply procedure codes appropriately. This accuracy will ensure following of compliances, and speed up the revenue collection process.
Track the source of denials and ensure they do recur in future. 40% of denials are due to errors in eligibility (conduct reviews on the same). Check the scheduling procedure details of CTs, MRs and PETs.
Negotiate well with insurance providers by furnishing your details, and data of the volume of services and benefits provided by your radiology department.
Due to high-deductibles and HSAs, patients have to end up paying more. The best policy is to take the details of the credit card of the patient or set up an automated payment schedule before the patient visits the doctor for the appointment. This significantly reduces delays in payments.
Verify details of 'with and without contrast' bills. It is important that invoices are clarified with the physician and then billed to the insurance payer.
Radiology Billing and Coding companies offer a streamlined revenue cycle management system for radiology billing and coding and aid in mitigating adverse effects of claim denials, resubmission delays etc. They are well aware of applying the right CPT codes and modifiers to increase billing and clinical efficiencies, and revenues through insurance authorizations, verification, and charge entry, coding and denial management. They also simplify processes of radiology billing thereby increasing collection rates, referrals, and possibilities for diagnostic research and development.
Published By - Medical Billers and Coders
Published Date - Nov-08-2016