Radiologists may well derive considerable satisfaction from practicing their profession, but they are not so fond of such ‘supportive’ occupations as billing and reimbursement procedures. A few practices and radiologists try to navigate medical billing and coding on their own, and it costs massive amounts of money and time on training employees, compliance updates and the constant battle with the competitive market.

It is projected that for 1000 procedures 1000 CPT codes must be assigned and the same number of ICD-10 diagnosis codes as well.

This to a great extent increases the challenges of radiology billing and coding. In addition to these particulars many other factors and regulatory policies play an important role in the processing of radiology bills.

Radiology coding is a composite of the following: X-rays, fluoroscopy, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine.

To optimize revenue generation, consistent cash flow and smooth operations in your facility, you must establish an organization-wide strategy. But to accomplish the best for your practice, you need to start from the roots: challenges in radiology billing.

What is Making Radiology Billing a Constant Struggle?

Radiology billing is challenging because of its complex nature for billing. Some of the significant hurdles include:

1. High Volume of Claims

Many radiology departments manage vast patient turnover, resulting in a large number of claims to process. Balancing clinical and administrative responsibilities simultaneously is a difficult task when you are not fully equipped with radiology billing and coding regulations.

2. Complex Documentation

This is very important since radiology billing requires documentation that is accurate to the highest level. Every action in the process has to be documented starting with the patient description and moving toward the details of the imaging study to match the claim to the payer requirements.

3. Changes in claim submission requirements

Another fact is that there are many changes or updates in the regulations with intervals of less than a year. Along with that, different payers have different documentation requirements which makes the billing more tedious.

4. Requirements related to Medical Necessity

Another problem area that often draws payer focus on claims is medical necessity. The radiology services have to be legitimate under the clinical need for the procedure supported by enough documentation.

5. Complex coding

Radiology coding comprises of so many codes that can be used in delivering a procedure. Overall, it is simple for coding mistakes to happen with regards to radiology services if the coders lack adequate information on the revised coding information.

6. Time-consuming

When it comes to radiology, billing takes a lot of time because there are several processes to be followed. For instance, the file needs to be reviewed or audited, codes have to be assigned, and claims have to be filed with insurance companies.

Tips to Optimize Your Radiology Billing Services

According to the American College of Radiology, several components should be included in the diagnostic imaging report, they are; patient identification information, clinical history, findings, diagnosis/ impressions, reporting physician’s signature, diagnostic study details.

It also mentioned that reports should be concise and easy to understand and should be submitted within 24 hours for most types of studies to increase the efficiency of communication.

For coders it is important to learn that the views for a radiology exam must be determined by actual documentation, not the department guidelines. To do that, it is necessary to count the steps correct and choose the proper CPT code for billing.

Diagnostic nuclear medicine and PET studies for radiopharmaceuticals are not included in procedure codes and are required to report in separate supply codes. This provides transparency and adherence to the billing standards/ regulations and helps you ensure timely and accurate reimbursements.

Some additional tips for enhanced radiology billing are-

• Maintain accurate and comprehensive documentation
• Stay updated with the latest coding and billing regulations and guidelines
• Use automated billing software to eliminate the errors and burdensome paperwork

Before You Go,

Are your claims denied due to lack of the right data, coding error and other preventable issues?

Do you think you are missing out on revenue even after putting hard work into practice?

Are you feeling overwhelmed with administrative burden and yet struggling to feel the positions in your facility?

If you have answered ‘Yes’ to all these questions, you can opt for an outsourced radiology billing company!

A healthcare revenue cycle management organization specialized in radiology billing and coding can be your reliable partner on the way of revenue generation and practice growth.