There are many hurdles during the process of radiology billing reimbursement. Claim rejection and postponements are not only disappointing to your imaging center but also showcase the extended timeline inpatient care, idle machines, and wasted physician hours. From the past few years, imaging centers have observed an increase in prior authorization declinations. Furthermore, in some scenarios, it is about 300 percent. The rising number of processes needing authorization, imaging centers all over the country came across problems with matching clinical necessities owing to the absence of documentation from referring physicians and continuous fluctuation to payer and advantage manages guidelines and policies.
As far as diagnostic imaging centers are concerned, the saying for medical billing “if it is not documented, it was not done” is very applicable. Wherein billing revolves around extremely accurate documentation and coding. There is a connection between delay in the initiation of cancer treatment and escalated death’s risk. According to the American Society for Radiation Oncology’s survey, in 2018 around 93% of oncologists said their patients are delayed from crucial treatments owing to proper authorization necessities, and 31% said the average duration of treatment delays by more than five days.
Keeping all aspects of medical billing here are five common radiology billing mistakes that affect reimbursement:
1. Lack of prior authorization
Usually, health carriers need prior authorization specifically for advanced outpatient imaging procedures like PET scans, nuclear cardiology services, CT scans, nuclear medicine studies, MRAs, and MRIs. Before scheduling the imaging procedure the provider, who is suggesting a patient for one of these procedures is accountable for prior authorization. Nevertheless, the suggesting care provider could be contacted by the imaging care provider and ask that before scheduling the imaging procedure, they can attain a prior authorization number.
Rejection of claim could happen if a prior authorization is not reviewed or requested. Moreover, there could be chances that members are not billed for services. To receive reimbursement, the prior authorization has to be supported by medical requirement, charged by the provider listed in authorization or suggestion, and charged on time. All the mentioned requirements must be fulfilled in order to get reimbursement.
2. Incomplete imaging report
The American College of Radiology needs that all imaging reports integrate the following information that should be required for a complete imaging report:
- Description of exam, sequences, and/or technique
- Exam name
- Physician’s signature
- Comparison studies if applicable
- Clinical indication/reason for the exam
- Conclusion and recommendations, if directed
From a coding point of view, other important components comprise laterality. Missing any of these components, and your compensation may be postponed or decreased.
3. Incomplete information in the claim
Accuracy plays a very important role in prior authorization. Incomplete information may welcome denials. Missing any of the information mentioned below could result in rejection or postponement of service.
- Patient identification and group number
- Ordering care provider’s name
- Patient phone number
- Ordering care provider’s email address
- National Provider Identifier number
- Patient date of birth
- Ordering care provider’s mailing address
- Ordering care provider’s phone and fax number
- Patient name
- Patient address
- Ordering care provider’s tax number
If a claim is denied for incomplete prior authorization procedure owing to the representation of incorrect insurance information to the care provider, the rendering care provider may submit an application.
4. Improper patient identifier information
Entering inaccurate information is quite dangerous than missing information. In order to make sure timely payment, keep in mind the name of the patient should be entered correctly. In addition to this, the patient’s birth date and sex should be entered correctly, the proper insurance payer is entered, and reviewing policy number. Apart from this, other information like cross-checking whether the claim needs a group number, diagnosis code meets the procedure offered, and the relationship of the patient to the insured should be correct. In the case of several insurances, ensure primary insurance is listed.
5. Termination of services or not covered
Knowing the insurance plan of a patient and the services you are offering is essential. It is important to review the patient’s eligibility whenever you provide services, because insurance data may change. Furthermore, it is also important to crosscheck other parameters such as termination of coverage, services that you offer are part of their plan and reviewing the maximum benefit of the cover has not met. It is highly important to review the patient’s insurance-related information. If you fail to do so you might face consequences like claim rejection and delay in reimbursement.
We offer rejection management and prior authorization solutions all over the country to support imaging centers to save and enhance revenue performance. Moreover, we have an expert team of billers and coders that efficiently handle common radiology billing mistakes. Discover our customer-driven medical billing solutions to reduce your billing workloads. Fill free to contact us and take a deep dive into our prominent billing and coding solutions.