How Radiologists Can Refine Their Revenue Cycle Management (RCM) With Radiology Billing Specialists

The emphasis on Revenue Cycle Management could never have been so high as it is now – as radiologists begin to comply with of the Affordable Care Act’s (ACA) requirements, they would realize the importance of reinvent their billing and revenue cycle management process to suit the bundled care, shared risk, and quality-driven reimbursement models. With fee-for-service likely to be phased out in favor of value-based service model, radiologists’ revenues may be vulnerable to reductions or long hold-up at the hands of either public plans such as Medicare, Medicaid, or commercial payors. In fact, the population health management requires diagnostic radiologists to adopt shared-risk model with in a period of five years or so. Therefore, radiologists will be under the obligation to coordinate and conform to performance standards for diagnostic services, rendered to both Medicare-supported beneficiaries as well as commercial insurance beneficiaries.

While displaying the requisite level of diagnostic competence may qualify them for value-based reimbursements and incentives, it is no guarantee that they automatically get converted to monetary returns unless they have substantially modified their medical billing and RCM process to the demands of value-based reimbursement model. Notwithstanding radiologists’ internal billing resources, it may not be possible to maneuver through a more regulatory payment environment without an exclusive third party diagnostic radiology Revenue Cycle Management specialist or specialists. The advantage of having such specialists onboard your Radiology Billing and RCM is that they prove catalytic in the entire process of RCM cycle, comprising:

  • Credentialing with inclusion of turnkey services, payer enrollment and contracting, credentialing and verification services, state medical licensing services, and personalized attention for individuals or group radiologists
  • Patient Access with key demographic patient information – including name, social security number, and insurance coverage – to serves as the foundation for payment of services. It is critical that this information be accurate, and linked to other billing functions from centralized registration or pre-registration systems.
  • Accurate and timely charge capture to make sure that all radiology services produce payable claims; it may be remembered that reconciliation of procedures-to-charges will help confirm that an accurate number of claims have been generated.
  • Coding powered by automatic and electronic coding of ICD-9 and ICD-10 codes, supervised by trained coders that specialize in CPT, ER and E&M coding
  • Billing, complete with electronic claim submission, posting denials and aggressive follow up of delays and denials
  • Collection with emphasis on conversion of older account receivables first and within the permissible time limit.

As radiologists seek to uplift their revenue fortunes with Radiology Billing Specialists, offers to mediate the employment of radiology billing specialists, who are capable of:

  • Keeping reimbursements as per negotiated fee schedules with Medicare, Medicaid, or commercial health insurance carriers
  • Guaranteeing payment contracts as per prevailing market
  • Minimizing A/R days through complete and timely charge capture
  • Enhancing payment accuracy with line-item posting of charges and payments
  • Averting risk through the industry’s most comprehensive compliance program