The frequent technological changes and additions to the specialty of radiology create administrative difficulties for healthcare providers. Most of the time, radiologists do try to take up the challenge and try to manage the medical billing process. However, radiology medical billing presents numerous difficulties, making it burdensome and stressful.
No matter how challenging the process of medical billing is, healthcare providers need to achieve adequate revenue. This is essential to maintain the workflow of the practice and improve the quality of patient care.
The range of complexities is greater and ways to handle them efficiently are limited. Radiologists perform various imaging procedures, and each one has a different CPT code and ICD-10 code. Apart from that there are billing and coding rules, along with regulatory guidelines. All this can be overwhelming for healthcare providers.
The wide scope of radiology and billing intricacies can be confusing for you, and this might be a roadblock in your journey toward earning sufficient reimbursement. That is why we bring you this blog. It includes vital information about the medical billing for the specialty of radiology. This will clear up your doubts, making it easier to improve revenue cycle management.
The Process of Radiology Medical Billing
The process of medical billing is quite similar for all the medical branches. The only thing that complicates one from the other is the nature of treatment and various CPT codes.
Similarly, the medical billing process for radiology begins with the first step of registration. This step is meant for pre-authorization and insurance coverage verification. Both of these decide if the healthcare provider will be paid for rendering services or not. This is also important to lay patient responsibility.
The next step is offering the service and capturing the charges for it. After this, the usual process of claim filing and claim submission is performed.
The process sounds simple, but it can be hectic and when done improperly, it can lead to manual errors that result in mistakes during claim filing. This further develops into claim denials and healthcare providers are on the receiving end of revenue loss.
Areas of Issues in Radiology Medical Billing
Coding Challenges
Coding appears to be the biggest roadblock in medical billing when not done properly. The same issue is with radiology medical billing, where coding challenges limit the financial posture of the practice. The three major challenges are the wrong usage of modifiers, over-coding, and under-coding.
Modifiers
Pairing the right modifier with the radiology procedure is essential to billing the exact services offered to the patient. If this is done incorrectly, it will affect the claim filing and claim submission. This usually occurs as radiology is a branch and many umbrella terms with different procedures under one specific type. Modifiers help in distinguishing treatments and help healthcare providers receive revenue for the same.
They are based on two components: a professional component and a traditional component. The professional component is termed, “26,” and the traditional component is termed, “TC.”
CPT codes for procedures illustrating professional components must be attached to 26 and the ones with traditional components must be attached to TC.
Under Coding
When a small degree procedure is coded wrongly under a code that depicts a higher degree procedure it is called over-coding. This is frequent in radiology medical billing. The issue with this is that it leads to lesser reimbursement as the revenue rate is not suitable for the service.
Over Coding
This is the opposite of under-coding, and the coding is done for a higher degree procedure. This results in a higher revenue gain as the reimbursement rate is high. This is problematic for the radiology practice as this leads to legal consequences. If a healthcare provider or practice indulges in over-coding, it is considered deceitful.
Other Challenges of Radiology Medical Billing
Limited Availability of Time
Radiologists are busy professionals constantly surrounded by patients of all kinds. This is because they are in charge of other healthcare providers and offer radiology assistance in various medical procedures and treatments.
This leads to a time shortage leaving little to no time to manage the medical billing process. This also limits them as they may not be able to keep up with the changing regulations and policies. The availability of time is always narrow, and they have to resort to other ways. Many healthcare providers opt for radiology medical billing services to improve their revenue cycle management.
Vital Measures to Make a Difference
Radiologists can take a vital step toward improving their administrative flow and better revenue management. This is possible with some measures such as:
Follow the Process Sequentially
The first step holds the utmost significance, and it must be done accordingly. A failure to follow this step, in the beginning, can deprive healthcare providers of getting their fair share.
That is why it is essential to follow all steps in the medical billing process.
This ensures that everything is done in continuity, and nothing is missed. This can be a good habit to improve the revenue cycle and streamline the workflow.
Focus on Coding Expertise
We know that coding can decide if a healthcare provider is going to receive enough revenue or not. There is a need for expertise in this department so that there are fewer denials and adequate revenue. You must also prevent mistakes like over or under-coding and place the correct modifiers in the right place.
Considering the number of codes in the specialty of radiology, ensuring the right codes is quite a task. That is why healthcare providers must think of mastering this field with expertise. Either they must know all the codes themselves or they must partner with a team of professional coders.
Invest in Denial Management
Denial management is an indispensable part of medical billing and healthcare providers must not ignore it. It can bring back a considerable part of revenue lost in denials with some minor corrections and resubmitting the claims
Other than that, it also helps in taking proactive measures to prevent future denials. The focus is on identifying the root cause of denials and ensuring that such errors are not repeated. Healthcare providers should not avoid the benefits of denial management and invest their time and resources in maintaining it. This will help boost the medical billing process along with the bottom line.
Partner with Radiology Medical Billing Services
There is no doubt that medical billing is complex and can take up a lot of time, resources, and energy. That is why it is acceptable for radiologists to feel burdened. However, medical billing services are one way that proves to be beneficial for healthcare practices.
Radiologists must choose to outsource and shift their administrative workload. On the one hand, medical responsibility is transferred, and there are other advantages.
Achieving an Edge with Radiology Medical Billing Services
Expertise In the Specialty
Professional medical billing services are experts in various specialties, and they are well-versed in all the difficulties of any medical branch. This gives you an edge as they can deal with radiology medical billing effortlessly.
Along with that, they help you achieve your financial goals and work to improve your financial posture.
Zero Hassle of Coding Errors
Clearly, the help of expert coders will prevent mistakes and shortcomings in the coding process. This will lead to fewer denials and revenue losses. As they are experienced coders, they know how to deal with situations like under or over-coding. Other than that, they are proficient in pairing the right modifiers as well.
Proper Compliance
Regulatory compliance can be tricky as rules and policies are dynamic and keep changing. However, it must be followed to protect the practice from legal situations and its reputation. In medical billing, protecting patient information is the most important. Medical billing companies ensure that they follow complete compliance such as HIPAA.
Streamlined Revenue Cycle
Proper management and follow-up procedures can improve the workflow and elevate the revenue cycle. Outsourcing partners ensure that they lift the financial performance of the practice and offer all services for it.
As a result, radiology medical billing gets simplified, and leads to positive results such as a boosted revenue cycle and smooth workflow.
To Conclude
A radiology medical billing company can solve the problems of radiology medical billing and improve overall financial performance. That is why radiology practices must leverage this opportunity and partner with radiology medical billing services.
Unify Healthcare Services is a leading medical billing company in USA with proficiency in radiology medical billing. Our team is adept at solving the intricacies of medical billing and coding. We offer customized solutions to fulfill the unique needs of your healthcare practice.
Partner with Unifyrcm and take your revenue cycle to the next and higher level.
