Experts have stated that for every 1000 performed procedure, more than 1000 CPT codes needed to be identified, and also an equal number of ICD codes are also needed to be applied. However, these codes definitely add significant complications to radiology billing. The components of radiology billing include:
- X-Ray
- Computed Tomography
- Magnetic Resonance Imaging
- Fluoroscopy
- Nuclear Medicine
In the last decade, compliance rules changed, physicians get lesser reimbursement, the high-deductible health plans are common, and cost of employing staff to provide radiology services has also significantly increased. However, as the healthcare staff stay busy with administrative hassles, that’s why it can be a feasible option to outsource radiology billing solutions in that matter. But before diving into how they can help, let’s learn about the radiology components, challenges, and best billing practices.
Technical and Professional Components in Imaging Centers Billing
Any diagnostic examination generally has two components, like technical and professional components. Let’s dive into them one by one:
1) Technical Component
This is the fee for the equipment usage, materials, and employees to perform the imaging scan. For example, the imaging center owns all the MRI machines charges for this component.
2) Professional Component
This component is the interpretation of the radiologist, and it is used to prepare the imaging report. However, if the physician is not a staff member of the imaging center, then they charge the professional component.
When these two components are billed together, global billing happens which combines all the technical and professional charges into one single claim. Properly identifying the billing process is the key to accurate reimbursement.
Challenges in Radiology Billing
The radiology billing challenges start from eligibility and benefit verification issues to technological issues. Not properly solving these challenges can make or break the clinic’s revenue cycle.
1) Patient Eligibility and Benefit Verification
Each payer has different rules, and pre-authorization needs. So, when you are trying to verify the patient’s eligibility for different payers, then you need a lot of time for these. Moreover, tiny mistakes such as incorrect policy or misspelled names can also lead to claim denial. Manual insurance verification takes a lot of time and is prone to errors.
2) Prior Authorization Issues
Prior authorization is a highly complex process and takes a lot of time to perform. It is because first you need to verify the patient’s insurance eligibility, gather all the necessary information, submit PA requests, track and follow-up, and appeal denied claims. It is a lot of work to perform for the clinical staff.
3) Technological Issues
RCM providers who depend on manual coding go through several problems like human error, slow rate of processing, and inefficient process management system. So, it is very difficult for the healthcare staff to learn as they need to cater to their patients also.
How to Improve Radiology Billing Practices?
The radiology billing practices include using technology for collections, to avoid backlogs for Imaging Centers Billing. Let’s have a deep dive in these practices:
1) Using Technology for Collections
Though you get the insurance payments, there will be uncollected balances and the practices will then contact the patient for payment. However, the current account receivable standard is to get patients 30 days after initial statement. You need to learn how to work with the Electronic Prior Authorization (ePA) to submit claims electronically to make sure this issue doesn’t occur. Hence, this can be helpful to increase your cash collection rate significantly.
2) Outsourcing As An Option
The radiologists juggle multiple priorities of patient care as they work in radiology clinics and health systems. When you add billing tasks to the responsibilities, it results in piled up tasks and delayed reimbursement process. So, outsourcing to the radiology billing outsourcing company can be highly effective so that your staff can focus on patient care.
3) Checking for Pre-Authorization
Start the verification process when the patient schedules an appointment. Also use automated verification tools to pull accurate insurance information in real-time. The imaging centers need pre-authorization, hence confirming if the procedure needs prior approval or not is an important process.
4) Keeping Records Updated
Explaining all the out-of-pocket expenses to the patients is highly important to make sure no issue occurs. Moreover, educating your staff about the insurance terms, consequencues for incorrect information entry and coding needs is highly important.
Taking the Assistance of Radiology Billing Services
The outsourced companies help with the billing process of MRI, XRAY, nuclear medicine, Ultrasound and interventional radiology procedures. They also provide customized reporting and have a free transition process. Moreover, these outsourced experts can reduce your operational costs by 80% and have a quick turnaround time. These external services also provide dedicated account managers and 10% buffer resources in case any issue occurs. They also provide 99.9% accuracy and 100’s of references in case any issue occurs. These experts also help with DME, cardiology, infusion, orthotics and prosthetics, gastroenterology, and many more specialties. So, if you want to streamline your billing process, it can be a feasible option to take the help of a radiology billing outsourcing company in that matter.
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