Radiology Billing Process – Everything You Need to Know About It

Introduction

Most radiologists love their profession. However, many of them fear the back-end work they deem cumbersome—billing and reimbursements. Some radiologists and healthcare providers try to manage medical billing, coding, and reimbursements on their own. However, this usually involves heavy investment in employee training, staying updated on compliance changes, and competing with other hospitals and clinics.

For every 1,000 procedures conducted, above 1,000 Current Procedural Terminology - CPT codes for Radiology Billing must be assigned and correlated with an equal number of diagnosis ICD-10. This further adds to the complexities of radiology billing and coding. Over and above this, radiology billing involves multiple compliance requirements, which must be followed exactly.

Radiology coding constitutes various components like X Ray, Fluoroscopy, Computed Tomography or CT, Magnetic Resonance Imaging or MRI, Nuclear Medicine.

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The Pain Points of Radiology Billing Compliance

Increasing Administrative Burden

A radiologist spends most their day responding to patient's needs and is often in standby mode for emergency diagnoses. This cannot be added to their schedule or that of their support team. Even a group of experts in medical billing and coding can become unproductive, with a backlog of accounts yet to be claimed resulting in delayed reimbursements as well as pressure from clients for quick payments.

Difficulty at Being Profitable

The profit margins for independent radiology clinics and hospitals are being reduced by the falling reimbursement rates and the increasing operational costs. Inefficiencies or errors in radiology billing and coding will only worsen the financial challenges and reduce profitability.

Technological Gaps

This leads to human errors, slower workflows, and an inefficient RCM system, as reliance is made on manual coding and claims processing. Overcoming such issues calls for automation and specialized tools for radiology billing.

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Tips to Improve Radiology Coding and Billing

Start with the Basics

Make sure all reports include basic details. Missing out on important information can lead to claim denials. These are:

Heading

Number of views

Reason for examination (clinical indication)

Findings

Synopsis

Physician's signature

Supporting films

Know your CPT Codes on Your Fingertips

A good knowledge of CPT codes is important for appropriate billing and coding. Here are some common ones: 

70010 – 76499: Diagnostic Imaging

76506 – 76999: Diagnostic Ultrasound

77001 – 77022: Radiologic Guidance

77046 – 77067: Breast Mammography

77071 – 77086: Bone or Joint Diagnostic Studies

77261 – 77799: Radiation Oncology

78012 – 79999: Nuclear Medicine

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Verify and Check

Verify all report numbers: Denial of claim result may be due to error in view number listed and not provided.

Components-Patient/Professional/Global Explain and Code the Right One

You must correctly know and code the following elements correctly:

Professional Component 

These encompass the interpretation and physician report. Modifier 26 Use

Technical Component: Such elements as equipment, staffing, and supplies consumed when performing the procedure should use the modifier TC.

Global Component: Situations when the physician owns the equipment and reports.

All-inclusive documentation

Hence, the healthcare service providers must provide all the necessary documents in Radiology Insurance Claims. Denials are a common scenario when image documentation is missing. For instance, a full abdomen study using CPT Code 76700 must have images from bile ducts, gall bladder, liver, pancreas, kidneys, spleen, inferior vena cava, and upper abdominal aorta. The lack of some of them delays the submission of claims.

Such issues need efficient communication tools. As an example, a special portal to raise documentation request directly with the healthcare providers will make it easy so that payout cycles reduce and settlement is done quicker.

Conclusion: Should you outsource or use a Radiology Billing Software to meet challenges?

How effective is your current radiology billing process? How often are claims being denied or rejected due to preventable errors such as missing data or coding errors? Radiology billing and coding services from One Point One Solutions reduce errors, streamline processes, and increase reimbursement rates to significant levels. Our bespoke solutions and technology-driven approach address inefficiencies, ensuring smoother processes and better revenue outcomes for radiology practices.

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