What Is Radiology Billing?

Medical billing is a vital part of any healthcare organization. It ensures timely payments and one such process is radiology billing, focusing on radiology services. Yet, many healthcare providers get disheartened when optimizing this process due to recurring claim denials. So, what is radiology billing? How do you solve its most common denials?

In this article, we’ll elaborate on the importance of radiology billing and highlight the key errors that may result in denials. We’ll also give you insight into how to utilize outsourcing services to improve your business operations and drive better results.

Continue reading to discover all there is to know about and the best ways to optimize the process!

Understanding Radiology Billing

Radiology billing is the process of submitting claims and receiving payments for the services offered by radiologists. It’s distinct from other types of medical billing because it relies on imaging technology, resulting in specific procedural codes and detailed documentation requirements.

Since it manages the financial aspect of these services, it involves various processes, including coding, charge captures, claims submissions, payment posting, and denial management. This sector has to handle high volumes of complex services, so fast and effective billing operations are a must.

As radiology services range from 70010 to 79999 CPT codes, here are some of the most common occurrences:

• Ultrasounds: 76506 – 76999
• Mammograms: 77046 – 77067
• Diagnostic imaging (X-rays, CTs, MRIs): 70010 – 76499
• Radiation oncology treatment: 77261-77799

Common Denials in Radiology Billing

As medical billing is one of the most complex aspects of running a medical facility, common issues can result in claim denials. Some of the most notable are: 

• Coding errors: Occur when healthcare providers don’t use the appropriate standardized codes to describe the diagnosis and procedures they’ve used during patient treatment. Thus, the healthcare organization’s billing team must familiarize themselves with the most common ICD-10, CPT, and HCPCS used in radiology to prevent any issues.
• Lack of medical necessity: Another common problem in radiology billing is the failure to substantiate the medical necessity of your services. The insurance company can refuse to reimburse you if you haven’t included sufficient clinical records and medical notes that justify the reason behind the treatment.
• Incomplete documentation: Failing to capture the necessary patient, provider, and treatment documentation can also lead to claim denials. Remember that claims have standardized forms that oblige to the insurance company’s rules and guidelines.

Solutions for Lack of Medical Necessity Denials

As mentioned, denials occur when the insurance company has determined that your radiology services aren’t medically necessary. Since each payer has unique requirements regarding proof of medical necessity, you should ensure thorough patient care documentation when the patient arrives for their appointment.

First, you should document the patient’s symptoms, medical history, and diagnosis. You can also include any prior diagnostic tests and treatments alongside your physician notes explaining the radiology services’ reason. Before submitting the claim, remember to appoint the correct medical codes for each diagnosis, treatment, and procedure during the patient’s visit.

Next, you must always check the payer’s guidelines for medical necessity requirements to ensure that the radiology service is covered for the patient’s condition. If the service requires preauthorization, you should obtain a written or electronic one from the insurance company beforehand.

Timely Filing and Claims Submissions

You should focus on timely filing and claim submission when optimizing your radiology billing process. Many healthcare organizations overlook the importance of this initial billing step, and failing to ensure a timely claim submission can lead to lost revenue.

To begin, familiarize yourself with the claim submission deadlines established by the insurance companies you have to file the documentation. Each insurance company has its unique payer policy you should review. This will give you insight into the timeframe and the necessary documentation.

You can also invest in advanced billing software with automated features for tracking deadlines. These programs alert the billing staff of upcoming deadlines and ensure the claim submission process proceeds smoothly and promptly.

When it comes to submitting the claim, you need to prepare the needed documentation alongside the appropriate codes. Then, you submit it either through paper or electronic forms and continuously monitor it until you’ve received payment for your radiology services. Remember to verify insurance information before the claim submission to prevent errors and denials.

Denial Management and Appeals

Proper denial management is another important aspect of resolving claim denials in radiology billing. This process identifies, analyzes, and corrects denied claims to ensure your healthcare organization gets reimbursed properly.

Optimizing this process reduces the risk of financial loss and improves your overall cash flow. Here are the steps in denial management that can help address your radiology billing denials:

• Identification: Track your submitted claims and catch denials as soon as possible. Timely claim denial capture ensures you have the time to analyze the reason behind it, correct any issues, and resubmit the claim within the insurance company’s given deadline.
• Analysis: Analyze the root cause behind the denial to identify potential areas of improvement. Always review explanatory documentation such as EOBs and ERAs to determine the cause of the issue.
• Segmentation: After identifying the main cause of the denial, you should track it for future reference. Segmenting denials caused by a specific issue can help you prioritize the areas of the billing process you need to improve.
• Correction: Correct any potential errors while providing supporting documentation to prevent another denial. 
• Resubmissions and appeals: Always ensure a timely appeal within the insurance company’s deadline.

Outsourcing Solutions for Radiology Billing

Many healthcare organizations turn to external vendors to streamline their operations and maximize revenue. Not only can outsourcing improve your medical facility’s efficiency, accuracy, and financial performance, but you also gain access to an experienced team using state-of-the-art technology. 

Outsourcing radiology billing services to a specialized outsourcing company like ours can help you streamline operations and offload excessive tasks. We stay updated with the latest payer requirements and industry regulations, ensuring legal and regulatory compliance. Focus on your core responsibilities while we take care of the back office healthcare operations. 

Conclusion

Let’s recap! What is radiology billing, and how do you solve the most common denials within its specialty? This process is responsible for submitting claims and receiving payments for the services offered by radiologists.

After elaborating on the importance of billing for radiology diagnosis, treatments, and procedures, remember that it takes time to optimize the overall process by first identifying the key areas of improvement.If you’re having difficulty optimizing your healthcare business operations yourself, you can always turn to outsourcing services. Since many medical facilities want to focus on improving patient care, our team at CLICKVISION BPO offers tailored RCM services ready to meet your healthcare organization’s diverse needs.