Radiology Billing: Effective Approaches for Compliance and Profitability
Katrina Vastag |Your practice can’t get paid on time without efficient radiology billing. When you submit claims correctly, you can collect insurance payments for each patient’s visit, allowing you to optimize revenue for your facility. However, billing and coding involve professional and technical components that may introduce errors and inefficiencies, so you need the right training and technologies in place.
Below, our team from Weave offers tips on streamlining the billing process for your imaging center so you can prevent lost revenue and coding errors.
Understanding Billing for Radiology Services
First, let’s go over the basics. Radiology practices generally use two coding systems: the Current Procedural Terminology (CPT) and the International Classification of Diseases, Tenth Revision (ICD-10). CPT codes describe specific services provided, while ICD-10 codes describe diagnoses and medical conditions, offering context to patient needs.
Your team likely uses thousands of codes to describe various procedures, from a diagnostic ultrasound to screening mammograms. Documentation breaks even down further as well, as radiologists generally organize medical billing and coding into the following categories:
- The professional component: This encompasses the radiologist’s expertise and their interpretation of the report and imaging studies. Professional medical services might include supervision during the appointment, CT scan reports, chart notes, etc.
- The technical component: The technical portion covers supplies, equipment, and the radiology experts involved in the procedure. While the professional component focuses on expertise, the technical component includes the direct costs your facility incurs.
Common Challenges in Radiology Medical Billing
Radiology medical billing is not as simple as typing a few numbers into a computer.
With coding standards updating frequently, teams need continuous education to maintain accuracy. CPT codes are updated annually, so billing staff must stay trained on changes to prevent errors in claim submission.
You deliver diverse and intricate imaging services that require detailed documentation for accurate billing. A seemingly standard X-ray requires an array of professional, technical, and diagnosis codes. Radiologists must be trained on CPT codes across all nuclear medicine procedures, ultrasound imaging, X-ray scans, limited exam orders, and diagnostic services.
To avoid claim denials from insurers, you must adhere to payer-specific guidelines and federal regulations. This involves another layer of steps, such as pre-authorization to verify insurance coverage and patient billing for non-covered costs. If claims are denied, you must submit appeals as well.
Best Practices for Effective Radiology Coding and Billing
So, how can you navigate these challenges to ensure your healthcare providers are coding their services correctly? Here are a few best practices for effective radiology billing:
- Conduct regular staff training: Ongoing education on the latest CPT updates and regulatory changes keeps your staff up to date, ultimately ensuring compliance. You can encourage your team to take continuing education courses or participate in relevant conferences.
- Implement advanced radiology coding and billing software: Modern radiology information systems (RISs) and electronic health records (EHRs) help with accurate patient documentation and can streamline billing processes. We recommend integrating this technology with an automated payment collection platform and patient communication software to further streamline your medical billing process. Simple upgrades like digital forms ensure that all documentation syncs together and stays updated.
- Require detailed documentation: Ensure that your staff records all procedures and interactions thoroughly, as this supports accurate claims later on. Detailed documentation can be challenging when interacting with patients, so ensure you allow time for proper reporting.
- Conduct regular audits: We recommend conducting periodic reviews of your processes to identify and rectify any errors. For example, you may discover that one of your providers frequently leaves out ICD-10 codes in their claims, which can lead to denials as the insurance company will not understand the patient’s medical necessity. With your audit, you can ensure continual compliance to prevent unnecessary claim denials.
The Role of Outsourcing Radiology Billing Services
While the tips above can help you reduce errors and streamline the process at your facility, it might make more sense for you to outsource. When you outsource to a professional radiology medical billing service, coding professionals document your complex imaging scenarios efficiently and correctly on your team’s behalf. With this expertise, you can prevent common code errors while allowing your team to focus on patients instead.
Outsourcing your revenue cycle management can lead to increased claim acceptance rates and faster reimbursements as your specialists will dedicate their full time to getting payments from your insurance providers. You can use this increased cash flow to cover other facility costs.
Your dedicated service providers understand the latest regulation updates, which reduces the risk of audits and penalties. Whether you provide Medicaid services or work with a small, private insurance company, your billing team will know their compliance requirements, deadlines, and standards.
While outsourcing makes sense for many smaller clinics, it may not be necessary for you. You can also consider investing in supportive tools that empower your in-house team to succeed. For example, you can adopt radiology patient scheduling systems, integrated EHR platforms, and more that sync patient data seamlessly, ensuring nothing goes overlooked.
Streamlining your Billing Workflow with Weave Payments – Weave Webinar
Weave: Helping Healthcare Providers and Radiology Practices Streamline Payments
With efficient radiology billing strategies, your facility can increase revenue and maintain compliance. At Weave, we offer comprehensive payment tools designed to streamline your practice’s operations. From helping your staff communicate with patients to automating payment collections, we make practice management easier for your organization.
Get a demo today to discover how Weave can transform your practice’s efficiency.
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