Inevitability of the Electronic Radiology Practice and Its Effect on Radiology Billing

The advent of digital technology has been quite a boon to healthcare industry, more so to radiology, whose role in clinical diagnosis and planning the right course of medical intervention continues to be more critical than ever before. Physicians and patients’ reliance on digital or electronic radiology interpretation is so much that it is virtually impossible to practice radiology without a full-pledged digital or electronic radiology infrastructure. As a result, PACS and other web-based technology have become indispensable part of every radiology practice. While electronic radiology medium considerably reduces turnaround time and greatly enhances quality of image interpretation, radiologists may have to find ways to deal with its impact on Radiology Billing on account of:

  • Rules governing billing of electronic radiology services,
  • Complexities involved in billing, coding, and realization of radiology claims, and
  • Voluminous increase in electronic radiology cases.

In view of these intervening factors, electronic radiology practices may well have to devise billing system that is web-enabled, allowing them to print statements, view accounts and even view radiology transcription reports on-line. Moreover, they would need to get their billing system, custom-designed to have full access to every component of billing data. Within this broader operational frame-work, they should have a team of coders, A/R managers, accountants, radiology practice managers, and data processors to work collectively to ensure that each charge is captured and billed accurately and on-time. These staff should be encouraged to monitor and update collection protocols to keep pace with the shifting regulatory conditions. While contract negotiations remain a paramount concern, it is imperative that your billing is complete with:

  • Best practices related to procedural codes, including HCPCS and modifiers, to ensure that you are coding for the highest revenue.
  • Understanding of payer rules, including medical necessity and NCCI rules, to help minimize chances of an audit.
  • Sophisticated medical billing system/electronic health record with advanced claim scrubbing capability
  • Facility for submitting both UB04 and CMS-1500 claims.
  • Facility to follow on denials or delinquent claims

The benefits of having such a well-rounded Medical Billing system is that it

  • Can enable HIPAA compliant clinical and operational practices
  • Generates monthly reports specific to radiologists’ needs
  • Helps retrieve the required reports and demographic data computer system.
  • Enables electronic billing to Medicare or commercial radiology insurance payers
  • Can confirm receipt of all electronic claims and produce error reports to identify claims that are incomplete
  • Can correct claims immediately and resubmits them for processing.
  • Facilitates scanning all demographic data, charge and payment data and other correspondence into the system to help in efficient follow up, thereby creating a paperless system.
  • And more importantly, helps in implementing strong denial management systems to resolve the pending claims.

While it may seem a daunting task to have such a comprehensive billing mechanism in place to counter the demands of billing electronic Radiology Services, outsourcing should make it a lot easier. And, when it comes to outsourcing medical billing and allied services, has stood out to be a reliable platform for sourcing competent and experienced billing professionals. With a nation-wide affiliation with radiology billers, we look forward to arm radiology practices across the 50 states in the U.S. with exemplary radiology billing solutions.