Top 5 Inefficiencies in Radiology Billing and Coding

Radiology Billing

Radiologists are happy now, as they hate billing and repayments and try to avoid them. Some radiologists manage radiology billing, coding, and repayment on their own. So, they need to invest more in employee training, continuous monitoring, and competing with other clinics and hospitals. Radiology bill processing has many other factors and observations. Radiology billing codes include X-Ray, CT, MRI, Fluoroscopy, and Nuclear Medicine. Interventional Radiology (IR) is the most difficult clinical radiology billing and coding. It contains neuro-interventional treatments and endovascular surgery. Since technology is constantly improving, the number of treatments is also increasing. This will increase the lack of interventional radiology coders with expertise. Every day, interventional radiology coders must effectively keep up with the radiology billing code advances. This blog explores the challenges of radiology billing and coding. We will also discuss the 5 inefficiencies in radiology billing and coding. Eliminating these could help to regain major revenue.

Radiology Billing and Coding

Radiology billing involves complicated procedures, like coding, claim submission, denial management, payment posting, and revenue analysis. Each step requires detailed concentration to comply with enterprise regulations. Interventional radiology is often difficult to code. The greater the number of treatments performed due to technological advances, the more likely the procedures handling interventional radiology will transform. In this stage, it would be difficult to perform radiology coding. Radiologists can simplify their billing procedures and empty administrative hurdles by collaborating with a reputable radiology billing company. This allows them to focus on their core competitors. Radiology billing firms use skilled specialists with in-depth knowledge of the ever-changing radiology billing services. They leverage developed technology and software to efficiently handle claims, providing accurate coding and convenient submission. By allocating billing operations to professionals, radiologists can minimize errors, reduce claim denials, and further develop income.

Radiology Medical Billing

Challenges of Radiology Billing and Coding

  • Interventional radiology needs knowledge of coding as well as expert training and organizational resources. Particularly, the coding for neuro-angiographic treatments features some of the most challenging codes ever created. In addition to intraoperative radiography and transcatheter and endovascular operations, there are many blood vessel families. All of these factors cause difficulties.
  • Excluding the complexity of coding interventional radiology, other challenges with radiology billing and coding are lack of resources, staff shortage, and financial burdens. Finding an expert interventional radiology billing services coder is difficult due to the lack of labor in this radiology medical billing industry. They are expensive to recruit and hire, and their expenses can greatly affect the company’s finances.
  • Other challenges in interventional radiology coding are lack of physician documentation, keeping with the insurance rules, high volume of work, inadequate training, and high level of claim rejections.

Five Inefficiencies in Radiology Billing and Coding

1. Radiology Billing Pre-Authorization

As per a study report by Fathom, 12% of rejections are related to authorizations, and 90% of authorization denials are preventable. Before generating the service, the radiologist must confirm that prior authorization was received. Radiology medical billing payers keep raising the list of procedures requiring pre-authorization. However, for various reasons, a different procedure may be performed than originally authorized. Unfortunately, that only gets found once coding has been completed, and it’s too late to revert the authorization. The denial of prior authorization may happen due to the lack of experienced radiology billing and coding staff.

The procedure for authorization must be initiated at the time of the patient’s enrollment for an appointment. The reception staff at the front office must collect as many details as possible about the patient’s condition and the causes of the exam. All pieces of information are important, as it may be required for the radiology department to contact the related physician’s office. Also, the staff should confirm that the orders are appropriate and complete. In some cases, it can be seen that the referring office will have received authorization from the insurance company.

2. Non-specific Diagnosis Codes

In July 2015, CMS (Centers for Medicare & Medicaid Services) announced that the Medicare Administrative Contractors (MACs) would not deny claims founded solely on diagnosis code particularity during the first year of ICD-10-CM. Many practices took this as permission to report non-specific ICD-10-CM codes and still continue to report them even today.

These facilities and practices are struggling with processes in place to ensure that specific clinical indications are acquired. For example, instead of coding the general injury code, the type of injury(sprain) or symptom (pain) is coded. Reports for imaging for injuries should also show whether the exam happened during the treatment initial phase or healing phase, or it is a sequela of a previous injury.

3. Incomplete Documentations for Ultrasound Procedures

12.6% of exams billed completed do not have sufficient documentation, as per the Fathom report. Ultrasounds are classified as adequate or limited as indicated in the CPT® code descriptor. All items and organs mentioned must be imaged and documented to bill for a complete radiology medical billing examination. Let’s see an example, to bill for CPT® 76856 in radiology billing and coding the ultrasound pelvic, or real-time with image documentation with a complete evaluation of the urinary bladder, seminal vesicles (visualized transabdominal), evaluation of prostate and any pelvic pathology (bladder tumor, free pelvic fluid, enlarged prostate, pelvic abscess) must be performed. When radiologists fail to properly document complete procedures, your practice can miss 20 to 50 percent of the potential repayment, depending on whether you are billing globally or just professionally.

4. Missed Views
Counting views by referring to a radiologist’s dictation leading to underbilling for radiology billing services is not always exact. For example, in a knee test, if the radiologist orders lateral, anteroposterior, and oblique views on a knee, numerous coders will code a three-view knee study. However, it should be a four-view study because of the left and right diagonal views.
5. Failure to Capture MIPS Codes
CMS estimated that MIPS (Microprocessor without Interlocked Pipelined Stages) implementation could increase payments by 6.25% with up to a 9% penalty for 2020, meaning the level of participation could describe more than a 15% swing in reimbursement. Yet, practices continue to struggle to ensure their codes are correctly captured. Even with clear guidelines, the lack of training and a passion for coders to drill productivity metrics can make these critical codes miss. When you outsource your radiology medical billing, you get access to radiology billing and coding experts who have extended skills in radiology billing services.

Enhance Efficiency and Revenue for Radiologists with Radiology Billing Services:

Radiology Billing Processes
Radiology billing involves complex procedures like coding, payment posting, claim submission, denial management, and revenue analysis. Each step requires particular attention to detail and keeping with industry regulations. By teaming up with a reputed radiology billing services company, radiologists can streamline their radiology billing and coding processes and reduce administrative burdens. Radiology medical billing companies have experienced professionals with skills in the ever-changing coding and billing requirements. By entrusting radiology billing services to experts, radiologists can remove mistakes, reduce denials, and improve payments.
Revenue Optimization
One of the primary purposes of radiology medical billing companies is to increase revenue for their customers. These companies can help radiologists to optimize their revenue generation through their specialized professionals and reliable resources. Accurate coding is key for proper reimbursement. Radiology billing and coding companies stay updated with the latest coding regulations and guidelines. The experienced radiology billers and coders totally review medical documentation and records and create appropriate codes for each procedure. This concentration on detail minimizes claim denials and maximizes reimbursement possibility.
Denial Management

Denial management is another one of the critical aspects of revenue optimization. Radiology billing and coding companies have extensive experience negotiating with claim denials and comprehending the common causes for rejection. They employ visionary strategies to reduce denials, including detailed claim reviews, demanding denied claims, and implementing disciplinary measures to prevent frequent issues. Radiology billing and coding companies allow radiologists to realize their full revenue possibility by improving claim acceptance rates and minimizing denials.

Moreover, radiology billing services companies utilize analytics and reporting tools to observe Key Performance Indicators (KPIs) and financial metrics. These insights help to identify process inefficiencies, revenue reducing points, and areas for improvement. By applying data-driven decision-making, radiologists can enhance their revenue streams and make informed decisions in business.

Regulatory Compliance

Attaching to ever-evolving healthcare regulations, including HIPAA (Health Insurance Portability and Accountability Act) and ICD-10, is essential for radiology medical billing practices. Non-compliance can give outcome with financial loss, severe penalties, and reputational damage. Radiology billing services organizations specialize in guiding complex administrative measures, ensuring compliance throughout the radiology medical billing process. The radiology billing and coding companies constantly train their team on the latest radiology billing codes guidelines, ensuring correct documentation and billing procedures.

They implement strong privacy and security measures to protect patient data, reducing the risk of violations and safeguarding the reputation of radiology billing practices. Radiology medical billing companies also help with insurance verification and pre-authorization. They ensure that all necessary documentation is in position before services are generated. This foresighted method reduces claim denials and accelerates the reimbursement technique.

Cost Scalability and Saving

Managing an in-house radiology billing team can be costly for radiology practices, requiring new staff, training, software, and infrastructure investments. By collaborating with a radiology medical billing company, techniques can greatly reduce overhead costs. Radiology billing and coding companies work on economies of scale, allowing them to allocate the cost of billing resources across multiple clients. Through this shared cost model, Radiologists benefit from the expertise and infrastructure of the radiology medical billing company without having to pay for it.

Further, radiology billing companies deliver scalability to adapt to the changing needs of procedures. Whether developing the radiology billing practice or dealing with seasonal changes, these radiology billing and coding companies can quickly adjust their resources and infrastructure to handle varying workloads. Radiologists can scale their radiology billing services up or down as needed without the bother of recruiting, training, or managing extra staff.

How is MHRCM Medical Billing Different from Others?

Radiology billing and coding are among the most challenging tasks because of the growing techniques. The number of possibilities for care grows as technology develops. MHRCM can assist you in eliminating radiology billing and coding inefficiencies, if you don’t have qualified staff. MHRCM can help to eliminate these 5 inefficiencies in radiology billing and coding. Using accurate codes to file claims, we help practitioners get reimbursed quickly.

This boosts revenue and improves cash flow. Radiology medical billing services include clean claim submission, eligibility verification, and revenue collection. MHRCM helps to optimize end-to-end Revenue Cycle Management. MHRCM’s medical billing services include medical practices, hospitals, laboratories, and independent and group practices. To learn more about MHRCM’s radiology medical billing and coding service, contact our MHRCM team.

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