For decades, radiology billing was done manually, with the entire team spending hours trying to figure out the correct code to use for every claim. The truth is, billing is all about following patterns and instructions that can change at any time, just like the waves of the sea.
If you're reading this, chances are you are facing difficulties with your radiology billing, and yes, it can sometimes be very frustrating. Plus, it only gets worse when your claim is constantly denied because of something as small as using an incorrect modifier or an error in a patient’s DOB.
Let's face the fact: radiology stands on its own and has no comparison in the world of billing. It needs to be well-detailed and accurate, but it is also very comprehensive. From interpreting treatment into standardized codes to adhering to strict regulations, your team has to get it right every time.
And the inefficiencies? They are not always obvious, as they always hide behind a lack of clear structure in the billing process. Over time, these small inconsistencies can pile up, leading to delays, errors, and denied claims.
As a billing company that has worked with providers who have issues in their radiology billing and coding, here are five billing inadequacies that can lead to revenue loss and stunted growth in your practice.
Radiology Billing and Coding Explained
Before mentioning the billing, mistakes radiologists should avoid, let's first understand its meaning. Radiology billing and coding is the process whereby medical radiology services provided by radiologists are interpreted and represented with standardized codes used to receive reimbursement from insurance companies.
It simply means recognizing the correct Current Procedural Terminology and International Classification of Diseases codes based on the radiologist’s report and ensuring that claims are submitted in the right manner.
This system was introduced into the healthcare industry to ensure healthcare providers are properly paid for the services they deliver. It also helps them stay compliant with healthcare regulations and reduces the chance of claim denials, audits, and revenue loss.
The Importance of Accuracy in Radiology Billing
Accuracy is an important part of billing that cannot be overlooked or ignored. Doing so will cost the provider the right to get paid for their services, affecting the cash flow of their practice.
For example, after a radiologist interprets a scan accurately, they write the findings in a detailed report. But somewhere between this and the final claim submitted to the insurance company; a small error was made. This can be using the wrong code, a missing modifier, or an incorrect diagnosis pointer.
The result: claim denial, causing delay in payment, and ultimately a disruption in the practice's cash flow.
Common Mistakes to Avoid in Radiology Billing and Coding
Omitting Prior Authorizations Approval
Many providers often lose revenue due to negligence or overlooking the importance of submitting pre-authorization. Even those who do submit them can still face issues because of failure to double-check the authorization, omit important documentation, or failing to follow up after submission.
Pre-authorizations are a very complex process in radiology billing. Why, you may ask- well, insurance companies have different requirements for approval.
For example, one company might want providers to add clinical notes and diagnostic information; another wants details of other treatment options that have failed, with facts on why the specific treatment is chosen.
Some can even ask for all the details mentioned above.
When prior authorization is not submitted or approved, it causes claim rejections, and most of the time, patients have to cover the cost of their treatment. To receive constant reimbursement, providers must ensure their prior authorization meets the requirements of the patient's payer.
This also means your practice must constantly stay up to date with the changing prior authorization policies of every insurance company.
Incomplete Imaging Report
One of the prevalent issues radiologist faces during their billing process is submitting an incomplete imaging report. As a provider who wants to be reimbursed, reports should not be your utmost priority.
But why is it a common mistake?
Insurance companies often want an accurate and complete documentation that explains why the patient needs the imaging procedure. Submitting claims with the right report will result in claim denial or down coded services.
To stop this from happening, radiologists must ensure all their imaging reports follow a consistent structure (e.g., indication, technique, findings, and impression). It should also contain information that shows the patient's clinical history, making the test a necessity.
Not Using the Standard Codes
According to the Centers for Medicare & Medicaid Services (CMS), using the wrong code is one of the leading reasons for claim denial, and it is also applicable to radiology billing.
Using code that does not match the treatment or coding for a more expensive procedure than what was performed can lead to severe consequences, such as claim denial and revocation of a professional license.
What you can do:
- Make sure coders are educated about the latest CPT codes and insurance guidelines.
- Documents patient's journey accurately
- Review each code to be sure that it matches the services that were provided.
Failure to Follow Up on Denials
Claims are sometimes denied even when everything is done correctly, and all regulations are followed. When this happens, the responsibility of a smart provider is to appeal the denial.
Many radiologists often do not do anything about the denial, making them lose a chunk of their revenue. This is because the insurance company will not give them what they rightfully earned without the right process.
By having a structured denial management process to track and follow up on every denied claim, every claim is addressed and resolved accordingly.
Outsourcing to denial management services will also relieve radiologists of constant spending on on-staff training. Working with a billing company that prioritizes denial management and resubmission will help identify the root cause of the constant denial and fix it.
Missing Documentation
Complete and accurate documentation plays a key role in the radiology billing process. Not including supporting documentation such as the following, when sending a claim to the insurance company may lead to rejection.
- Clinical notes or history
- Prior authorization forms.
- Missing signature on imaging report
- Signed order from the referring physician
- No documentation for modifier use
To stop this from happening, you must have all the necessary documents and add them to your claim as per the request of the insurance company.
Choose Right; Outsource to Unify Healthcare Services
Unify Healthcare Services offers top-notch billing and ensures radiologists collect their revenue. As a HIPAA-compliant and denial management services provider, we handle all your billing needs. From pre-authorization and accurate coding to denial management and accounts receivable recovery, our services make your practice's billing and operations seamless.
Your radiology billing and coding needs efficiency, and that's what Unify Healthcare Services offers.
