Radiology medical billing is a complicated process as it involves three stakeholders – the provider, imaging center, and patient. Processing a successful radiology medical claim requires coordination between the provider and the radiology center, accurate pre-visit insurance eligibility checks, comprehensive patient documentation, and accurate coding. A failure at any of these steps can lead to a claim denial or rejection.
If you are a radiology service and want to improve the patient experience and boost revenue collections, implementing these radiology medical billing tips can help.
1. Coordinate with the provider for prior authorizations
Failure to obtain prior approvals represents the most common reason for radiology denials. Any delays in insurance collection can severely impact the health of the patient.
As per a 2018 study by the American Society for Radiology Oncology( ASTRO), 93 percent of radiology oncologists say their patients have received delayed treatments because of prior authorizations, with 31 percent saying that the delay was longer than five days. Almost all carriers require prior authorizations for advanced imaging procedures such as PET scans, nuclear cardiology services, CT scans, nuclear medicine studies, MRAs, and MRIs. Although getting prior authorization is the provider’s responsibility (or the hospital’s precertification department), ensure that your billing staff obtains the prior authorization number before the procedure is scheduled.
2. Precheck the need for an ABN
If a specific radiology service is not listed by Medicare or Medicaid as a medical necessity, you must obtain a copy of the advanced beneficiary notice ( ABN) form signed by the patient. Ensure that the cost of radiology service (the professional fees and the facility fees) is included in the ABN. You must work closely with the referring provider’s office to ensure that the insurance eligibility has been verified and the ABN, where required, is obtained.
3. Document information comprehensively and accurately.
Capturing correct patient information is crucial in radiology medical billing. Every claim submitted must have the following basic details captured correctly:
- Patient information: Patient name, address, sex, identification, group number, date of birth, contact details, and insurance policy number.
- Provider details: The provider’s name, email address, NPI number, mailing address, contact numbers, tax number.
- Imaging report details*: Exam name, radiologist signature, the clinical requirement for the exam, comparison reports if available, findings, conclusions, and recommendations.
*Non-physician practitioners (NPP) authorized to supervise the performance of diagnostic tests include nurse practitioners (NP), physician assistants (PA), clinical nurse specialists (CNS), and certified nurse-midwives (CNM).
Occasional discrepancies in the documentation submitted with claims are inevitable. But it is vital to periodically review the denials due to documentation errors to identify training areas for your medical staff or the in-house billing specialist. Also, if you have created documentation checklists for different radiology procedures, review the additions/deletions to be made to those checklists every once in three months.
4. Focus on the 80/20 rule for reducing claim denials.
Assess the top 20 percent of claims categories that account for 80 percent of your collection delays and denials. As a radiology service, three categories may be your most significant problem areas – chest X-ray exams, non-invasive cardiovascular studies, and bone density studies. When it comes to these radiology studies, ensure that you are thorough in documenting the specific symptoms reported or diagnosed, the patient’s medical history, including the patient’s medications, and the medical necessity for the radiology study.
If you outsource medical coding and billing, have a regular dialogue with your healthcare billing partner and monitor the medical billing reports.
5. Stay updated on radiology medical billing guidelines.
The year 2021 saw the implementation of the revised E/M guidelines which have impacted radiology reimbursements. You can now document a visit based either on time spent with the patient or on the medical decision-making involved.
The decrease in radiology reimbursement rates for non-E/M services and the growing share of patient payments are just some of the current radiology practice challenges. To boost revenue collection, you must ensure that all insurance claims are collected in full and within a reasonable time. A sure-shot way of achieving that is to work with an experienced medical billing service.
If you have concerns regarding radiology medical billing, credentialing, patient billing, or delays in payment collection from payers and patients, feel free to contact us for a consultation.