Radiology billing is a complex process and involves precise documentation and coding skill. Billers require to be up to date with their knowledge, for even small errors lead to the rejection of claims. Depending on where services are provided – hospital setting or physician’s office – charges vary. Further, it is imperative to know current coding rules, codes and compliance guidelines. Being on top of all changes means fewer mistakes and increased revenue.
In recent years there has been a spurt in denials based on authorization issues. Delay in imaging leads to delay in treatment. In the case of some illnesses, delay in treatment results in adverse outcomes. Hence documentation from referring physicians and up to date knowledge of rules is crucial in radiology medical billing.
Common radiology billing mistakes to look out for are
1) Prior authorization is missing
Prior authorization is required for advanced imaging procedures such as CT scans, MRIs, PET scans, and nuclear medicine studies when done as outpatient services. The healthcare professional who refers the patient for the imaging procedure is responsible for requesting prior authorization before an appointment.
If prior authorization is not secured before rendering the procedure, the payor could deny the claim. To have the claim reimbursed without delay, the prior authorization must be backed up by medical necessity. Further, the claim must be submitted on time and submitted by the healthcare professional mentioned in the authorization. If one or all of these terms are not fulfilled, reimbursement can be delayed or even denied.
2) Incomplete claim form
Accuracy and completeness are vital when it comes to prior authorization. Any missing information may lead to denial or delay in reimbursement. The following details must be available
• Patient name, address, phone number, date of birth and identification number
• Ordering care provider’s name, tax number, NPI number, mailing address, phone number and email address.
3) Incorrect patient data
Submitting claims with incorrect data is a surefire way to have claims returned. Check twice patient data such as name, date of birth, payor name and policy number, name of insurer, and the insurer’s relationship to the patient.
4) Missing documentation
Some payors may ask for medical records that support medical necessity before they pass a claim. This may include the patient’s medical history, physician consultation reports, discharge summaries, and radiology reports. Medicare guidelines for radiology billing requires the medical necessity for claims processing.
Imaging reports should also be complete and contain the following information.
• Exam name
• Clinical indication/reason for the exam
• Description of exam, sequences, and technique
• Conclusion and recommendations, if indicated
• physician’s signature
Hence documentation is crucial while submitting claims to both private payors and State agencies.
5) Insurance does not cover services
Insurance eligibility verification must be done to check whether the policy covers the radiology services. The current status of the policy should also be verified by billers.
Bristol Healthcare Services, a medical billing company, is here to take care of your radiology billing. Our experienced and knowledgeable billers will ensure that there are no billing and coding errors.
We have been serving healthcare professionals for more than 20 years. It is led by people who have decades of experience in this industry. The billers and coders are also experienced and their expertise is continually honed through staff education as the industry is seeing changes regularly.
Bristol Healthcare will help with Radiology Billing
Bristol Healthcare Services has invested in excellent human resources, hardware and software to render superior services to the medical fraternity. Our mission is to make sure that your claims are passed the first time and that your cash flow is uninterrupted.
Partner with us for a mutually rewarding venture!