Learn how to improve radiology billing with outsourced services

 

Most radiologists struggle with medical billing and other paperwork, while providing imaging services. In radiology, there are multiple imaging tests conducted like X-ray, MRI, and CT scans to diagnose the patients which can be overwhelming, while each imaging procedure requires a specific set of medical codes for the claim reimbursement process. These claims, if not reimbursed, affect the revenue generation of the provider and impact the growth of the business.  

To improve efficiency and cut costs, radiologists are now outsourcing specialized radiology billing services. This not only reduces operational burden and accelerates claim reimbursement but also enhances patient care. However, ongoing billing errors in radiology remain a challenge, often leading to reduced reimbursements. 

Understanding the major challenges in Radiology Billing 

1) Multiple coding variations

These include diagnostic imaging billing services like MRI, CT scan, ultrasound, and X-rays. Each of these tests has specific coding requirements and multiple applications. A coder who fails to track these coding variations might miss out on implementing the correct code. This could lead to underbilling or claim denials, further affecting the revenue generation. 

2) Complex CPT codes 

The CPT codes for Radiology are frequently updated every year. Even minor updates on descriptors and bundling rules lead to major changes in the reimbursement process. The codes are differentiated by whether the scan was done without contrast or with contrast in the same session. Brain scans and spine regions require distinguishing whether it was cervical, thoracic, or lumbar, and require distinct codes depending on the use of contrast. This lack of knowledge on updated coding rules is another reason for frequent errors in radiology billing.  

3) Higher denial rates – 

The diagnostic imaging billing staff go through more payer scrutiny since every study must justify the necessity of the imaging. Claims are denied mostly due to incorrect coding or lack of adherence to payer policies and healthcare regulations. 

4) Detailed documentation requirements

Radiologists extensively record test details of patients and submit documents without any errors. Most of the radiology tests are performed based on the physician’s reference. Any missing information from the physician’s end will lead to discrepancies in the billing process.  

The role of expert billing professionals in rectifying errors 

The frequent errors in billing could be avoided if the medical billers implement the below mentioned techniques: 

1) Trained staff –

The third-party companies employ trained coders who have expertise in radiology coding services. Their knowledge of complex bundling rules and imaging techniques will prevent errors that may arise in the billing process. 

2) Real-time claim scrubbing –

If claims are scrubbed and reviewed in real-time, it removes errors related to modifiers, incorrect codes, bundling complexity, and incomplete patient demographics. It is necessary for imaging centers to have an effective radiology claims management service. 

3) Application of PACS/EHR/RIS integrated workflow – 

The storing, retrieving and sharing of medical images are done with the use of Picture Archiving and Communication System (PACS) or Electronic Health Record (EHR). The application of this updated billing software reduces the chances of manual errors in the billing system. The implementation of RIS (Radiology Information System) also assists in managing data and medical imagery. 

Key indicators of a reliable radiology billing company 

A company that will perform all the necessary steps for billing will have better operational efficiency in the market, when compared to other billing companies. Thus, it is important to keep in mind the following factors before partnering with an expert radiology medical billing solution. 

1) Industry experience – 

The verification of radiology services history provided by the billing company is necessary. Radiologists deal with multiple equipment for X-rays, MRIs, and ultrasounds. It is also important to ensure that the company has a track record of medical billing services performed for this kind of imaging. 

2) Connecting with other clients – 

A reliable billing solution will provide references to their clients with whom they have previously worked for. The radiologists or providers can connect with these clients to have a better understanding of the company’s services. 

3) Understanding professional, technical, and global billing components – 

Technical factors include all the supplies and equipment used in performing the scanning/test. For the global component, the physician contributes significantly to the report generation and bears the associated equipment and supply costs. 

4) Specialized support and communication – 

A professional radiology billing service ensures clear communication with the insurance company and the radiologists. This enhanced communication creates specialized support for the providers in fulfilling their billing requirements. 

The importance of outsourced companies in imaging center reimbursement 

Radiology specialists work with a variety of medical equipment that requires different codes and conditions for claim reimbursement. As a result, the medical imaging reimbursement process becomes difficult for the in-house billing teams. Outsourcing comes as a great help to radiologists since they offer an overall accuracy rate of 99%, first-pass rate of 97%, 2% of collections from AR and denial management, along with CPC-certified coders. If your radiology is facing issues with aging ARs, these companies will ensure 30% shrinkage of AR buckets within the first 30 days. Additionally, you will also receive the staff’s expertise in handling updated billing software like Tebra and Kareo for automation and reducing manual errors. 

What’s more interesting is that there are billing experts who provide dedicated account managers for every client. This gives them the opportunity to work on individual providers and their billing issues. The companies provide complete radiology revenue cycle management services, including both pre-billing and post-billing tasks. Their virtual assistant support services, including appointment scheduling, reminder setting, responding to patient inquiries, and managing voicemails, enhance remote patient support within your practice. Contact the experts now to ensure financial stability and revenue growth in your radiology practice.