Radiology is a high-volume field; consequently, medical billing and coding of this specialty is nothing less than critical.
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Radiology is a high-volume field; consequently, medicalbilling and coding of this specialty is nothing less than critical. Radiologists have been facing declining reimbursements due to the ever changing health care rules, increased costs of equipment, private payers adopting Medicare rates, and the consolidation of other interventional radiology and CT codes. Again, non-physician professionals, increased competition and an unrealistic focus on productivity is leading to declining reimbursements in radiology. Adequate documentation, apt charge insurers, best practices, regular auditing and documentation of all procedures and billing costs must be attained to enhance the radiology revenue cycle management process.
1. Coding inconsistency:
Radiology coding inconsistencies are very common. Many a times, the technician forgets to capture charges, update procedures or provide supplies' details. Again, the radiology billing department may not have the relevant documented details of the procedures. This causes costs reduction, greater denials, compliance issues and inefficiencies. Hence the need is for concise and complete documentation for apt radiology coding and accurate reimbursements
A regular workflow must be established between the radiology coder and physician. This can be easily done by a well-defined electronic query system (with automated reminders) to promote flexibility, clarity, transparency, information acquisition, for specificity or to determine the importance of certain procedures, pathological or radiological findings from the physician. Perform internal audits on queries and structure it according to protocols.
Partnership with a revenue cycle management company can work wonders for your radiology billing and coding. They are experts in reviewing documents, catch errors before submission, verify and submit clean claims, and follow compliances.
All coders must be certified, and credentialed after two years post apprenticeship. This way they stay updated and are aware of the latest codes and guidelines. Be it in-house or outsourced, continued education of coders is a must.
Due to high-deductibles and HSAs, patients have to end up paying more. The best policy is to take the details of the credit card of the patient or set up an automated payment schedule before the patient visits the doctor for the appointment. This significantly reduces delays in payments.
6. Referral errors:
Verify details of 'with and without contrast' bills. It is important that invoices are clarified with the physician and then billed to the insurance payer.
Radiology Billing and Coding companies offer a streamlined revenue cycle management system for radiology billing and coding and aid in mitigating adverse effects of claim denials, resubmission delays etc. They are well aware of applying the right CPT codes and modifiers to increase billing and clinical efficiencies, and revenues through insurance authorizations, verification, and charge entry, coding and denial management. They also simplify processes of radiology billing thereby increasing collection rates, referrals, and possibilities for diagnostic research and development.