5 Tips for Preventing Reimbursement Loss in Radiology Billing

New laws, regulations and rules have made the billing and coding for healthcare services more complicated and complex for all groups and segments of the medical industry including radiology. Radiologic groups and radiologists must adequately document the healthcare records of patients, correctly apply the billing codes for procedures performed and accurately charge the third party payers and insurers for the radiological services.
You should implement certain best practices to capture, process and audit every procedure for preventing reimbursement loss and this holds true whether you are outsourcing your radiologic billing or having it processed by your in-house clerical staff.
Five tips for preventing reimbursement loss in radiology billing are mentioned below:
1. Accurate Documentation and Coding
One of the main factors to increase your reimbursement rate is to improve the quality of documentation of records. If radiological records are inaccurate or inadequate, it results in faulty claims. Make sure that there is appropriate communication between the billing staff and the radiologists. This is necessary for the promotion of proper billing and procedure codes, which depends on detailed and accurate documentation.
If you give your billing staff accurate and complete information, it will not only speed up the collection and billing process but also improve compliance. For instance, an inaccurate radiological dictation may result in a denial, like the title of the report says “MRI of liver without contrast” whereas the body of report says “MRI of liver with and without contrast”.
2. Review Rate of Denial
Even in radiological groups that are well-run, up to 30-40% of denials are due to eligibility errors. To decrease the denial rates, have a meeting with your billers and discuss and review the results of denials and identify what is the source of defective data. It is recommended that you check online while scheduling radiological procedures such as MR’s, PETs and CTs.
3. Review Contracts
Evaluate current service contracts thoroughly. While you are conducting negotiations with payers, demonstrate the benefits your services have to offer and the volume of your services. Explain how denials and low reimbursement rate affects your radiological group. It is imperative to utilize accurate and reliable data while providing instances of inaccuracies in the system of payers.
In such circumstances presenting reporting modules, which provide support to your information and also reports strong payment analysis improves your leverage and trustworthiness while you are negotiating with your payers.
4. Collect payment from the patients (deductibles, co-pay) up front
Nowadays high-deductible insurance plans are becoming more common; hence, patients are taking more responsibility for paying the greater portion of their medical bills. It is therefore, another important way to reduce reimbursement loss in radiological billing, i.e. to collect payment when radiological procedures are done or even before the procedure is done. This may significantly decrease loss in radiological billing.
5. Eliminate errors due to wrong interpretation of procedure ordered by the referring physician
Eliminate errors that occur because of wrong interpretation of the study ordered by the referring physician. For instance, a physician may refer a patient for “a MRI head without contrast”. However, the radiologist does the procedure as “MRI head with and without contrast” and bills for both the procedures. The claim for this procedure will be denied as it is not the study originally ordered by the referring physician. If you have questions about the procedure, clarify with the referring physician or get an updated referral.



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