{"id":13393,"date":"2021-05-03T18:01:07","date_gmt":"2021-05-03T18:01:07","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=13393"},"modified":"2025-08-25T08:34:52","modified_gmt":"2025-08-25T08:34:52","slug":"how-to-manage-radiology-claim-denials","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/how-to-manage-radiology-claim-denials\/","title":{"rendered":"How to manage radiology claim denials?"},"content":{"rendered":"

When the radiology<\/a> physician submits the error-free claim on time then the practice\u2019s cash flow will improve and the overall operational cost gets minimized. However, you may find delays in payment due to radiology claim denials from the payer for some reasons.<\/p>\n

When claims get denied, the patient will be vulnerable first as the entire burden of paying back falls on the patient’s shoulders. In such situations patients tends to call the practice’s billing office to complain then the billing office need to handle the phone call, research the problem, obtain corrected information, and re-submit the claim within the stipulated time.<\/p>\n

Now, let us discuss how you can manage radiology claim denials:<\/h2>\n

Patient eligibility problems<\/h3>\n

Are you deeply observing the patient\u2019s eligibility before submitting the claim for Radiology services? Because the problems with patient eligibility can lead to a chance of encountering radiology claim denials. The problems with the patient’s eligibility include the incorrect insurance company (or plan) information on the claim or listing the incorrect site of service.<\/p>\n

Various payers especially Medicare<\/a>, expect all related information about the patient to correspond exactly with their records and a mismatch with the information will create a denial of the claim. This denied claim needs to rework by the radiology group to make the correction which adds extra effort.<\/p>\n

Apart from eligibility problems, providers should look for Prior authorization some services need PA for payments. Let’s discuss the assessment of PA requirements in detail.<\/p>\n

Assess pre-authorization requirements<\/h3>\n

The radiologist should obtain prior authorization before rendering the services as payments are denied for procedures performed without the required authorization.<\/p>\n

Radiology exams that may require pre-authorization include:<\/h4>\n