5 Tips for Preventing Reimbursement Loss in Radiology Billing

Rules and regulations have made the coding and billing for medical services more complex for all segments of the industry, including radiologic groups.  Radiologists and radiologic groups have a need to adequately document healthcare records, correctly apply billing codes and accurately charge insurers and other third-party payers for radiological services.

Whether you outsource radiologic billing or have it processed by in-house staff, it is to your benefit to implement best practices which capture, audit and process every procedure and document your billing costs to prevent reimbursement loss.

Here are five tips for making cost-effective improvements that can enhance your radiology billing and reimbursement process.

1. Accurate Coding and Documentation

Establish communication between the radiologists and the billing staff to promote proper procedure codes and billing, which depends on accurate and detailed documentation.  If radiological records are inadequate or inaccurate, it leads to faulty claims.  One of the primary keys to increasing your reimbursement rate involves the quality of your documentation.  

Providing your billing staff with complete and accurate information not only improves compliance, but also speeds up the billing and collections process.  For example, an inaccurate dictation may lead to a denial, such as a discrepancy between the head of the report that says an “MRI of the head without contrast” and the body of the report that says “with and without contrast".

2. Review Denial Rate

Even in well-run radiological groups, up to 40% of denials have to do with eligibility errors.  To reduce the rate of denials, meet with your billers to review and discuss the denial results and identify the source of faulty data.

Recommendation includes making an online check when scheduling procedures, such as CT’s. MR’s and PETs.  Referrers also have a stake in the problem because it is likely that they are experiencing the same issues due to bad data.  Make suggestions on how they can improve their processes to minimize denials, such as proposing that that they conduct eligibility reviews.

3. Review Contracts

Conduct a thorough evaluation of your current service contracts.  When conducting payer negotiations, demonstrate your service volume as well as the benefits of your service offerings. Explain how the low rate of reimbursement and denials affects your group.  It is important to use reliable and accurate data when giving examples of pitfalls in the payer’s system.

This is where having reporting modules that support your information and provide strong payment analysis reports improves you trustworthiness and leverage when negotiating with payers.

4. Collect Patient Portion of the Payment Up Front

If a patient can pay in advance, employ a service to charge their checking accounts or credit card each month.  With HSAs and high-deductible plans becoming commonplace, consumers are taking on more responsibility for a larger portion of bills for medical services.  Collecting payment at the time radiological services are rendered, or setting up automated payment schedule before the patient goes in for scheduled procedures can significantly reduce loss in medical billing.

5. Eliminate Referral Errors

Avoid doing studies that end up being denied because they do not meet the same type of study as the referring physician ordered.  A physician may order a MRI and specifies "without contrast".  However, the radiologist completes the study "with and without contrast" and bills for both.  The claim will likely end up being denied because it does not match the order received from the referring physician.

If there are questions about the protocol, speak to the referring physician to get clarification or an up-to-date referral.

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