Radiology is a medical specialty that uses imaging techniques such as X-rays, MRIs, CT scans, PETs, and/or ultrasounds to diagnose and check for injuries or diseases/abnormalities within the human body; and the physicians/imaging experts are known as radiologists. As the field is a niche, so is their medical billing and coding process cumbersome.
For the practice to thrive, the billing and coding experts have to be aware of the latest rules and regulations, along with being updated on the individual payer guidelines. Moreover, a coherent charge entry and charge capture process must be followed as it is one of the chief areas in radiology medical billing.
According to ecareindia.com, ‘In the medical billing charge entry process, created patient accounts are assigned with the appropriate $ value as per the coding and appropriate fee schedule. The charges entered will determine the reimbursements for the physician’s service. Therefore, care should be taken to avoid any charge entry errors which may lead to denial of the claims.’
Charge entry in radiology:
- Ensure that all encounter/patient visit forms have been received on a daily basis. Also, ensure that all the services that were rendered by the radiologist have been documented.
- Acknowledge all the forms and review them thoroughly for any errors or incomplete information. This includes verification of the patient account number before charges are entered into the system.
- Review daily logs and enter the charges which are mentioned on the charge sheet.
- Remember that all charges must be posted on the day of service.
- Before posting, thoroughly check all the fields afresh for accuracy.
- Ensure that the correct account has been selected of patients’ while entering the charges. Verify all the demographics data such as patient name, date of birth, address, etc. Also verify the ‘patient account number’ recorded in the medical document (consisting of face sheets, physician diagnosis, labels, etc.) while selecting the account and patient.
- Ensure that charge reconciliation is completed by the next day (maximum) of the charge entry process. This will keep ample time as provisions to correct any errors before bill submission.
- Billing errors need to be identified, along with a defined process set for improving them in the future.
- In radiology, the person responsible for charge entry is also responsible for coding charge slips with the appropriate ICD-10 and CPT codes for apt reimbursements.
Charge capture in Radiology:
Firstly, a charge description master (CDM) must be in place (especially for hospitals). An unambiguous CDM must have one procedure definition per procedure code. After checking prices and codes, incorrect coding if still occurs, is mainly due to a problematic charge capture process. There technically should not be multiple entries for the same procedure code. This CDM should also be matched to RIS. Compliances must be followed with respect to modifiers. The pricing policy of the radiology department/healthcare center too must apply to all charges.
According to radiologytoday.net, ‘There typically is an unintentional disconnect between finance and radiology when it comes to charging. The radiology IT staff is focused on providing what technologists need to capture what they’re doing and not necessarily focused on the resulting charges. In many facilities, opportunities can be significant. Be careful not to put a specific dollar amount on the anticipated opportunities lest your CFO budgets the numbers to your detriment.’
Secondly, diagnostic and interventional radiology procedures are being billed in as bundled codes. CDM must be updated regularly (every year) with the set of charges for the new bundled codes. Hospitals that deal in radiology charge capture must note the prices of the new bundled codes in the CDM and ensure that all procedural costs are reported.
The third is the front-end edit resolution. Either clearing houses/claim scrubbers/front-end editors or radiology medical billing and coding experts must review all fields before submission, be it for modifiers, unbundling codes, or other payer issues. As CMS has developed NCCI edits, these edit rules should be followed as they explain which procedural codes must not be bundled together in radiology as they are mutually exclusive or are a component of one another. Pre-bill editing functions must be performed and these bundling edits must be applied before claims are filed.
Lastly, denial management. Radiology experts must ensure that radiology specific denials and rejections are identified, tracked, and dealt with along with all charges captured for garnering appropriate reimbursements.
In radiology, charge capture and entry is extremely critical. It is essential to provide patient satisfaction along with having a high financial success.