Enhance Radiology Billing Process by Avoiding These 6 Mistakes

Mistakes are a natural part of life, but some can be very costly and have serious effects. In radiology, errors are not just small issues—they can have a major impact. A single mistake can lead to expensive billing problems, delays in payments, and a loss of patient-trust. To keep everything running smoothly and to provide the best care, it is essential to avoid some critical mistakes and ensure accuracy in all processes.

Thus, the pursuit of accuracy in radiology is not merely a technical requirement but an ethical concern too. It represents a commitment to excellence and a deep respect for the patient’s well-being. Ensuring precision and avoiding critical mistakes is essential for maintaining a smooth and efficient operation, safeguarding financial stability, and upholding the high standards of care that patients deserve. In essence, the endeavor to minimize errors reflects a broader dedication to integrity, reliability, and the profound responsibility of caring for others.

As far as radiology practices are concerned, the saying “if it is not documented, it was not performed” goes right. The health of the entire billing process depends on accurate documentation and coding.

Based on a survey conducted by the American Society for Radiation Oncology in 2018, around 93% of oncologists admitted the fact that patients have been delayed from critical treatments because of tedious prior authorization formalities. 31% of the participants said that the average timeline for the delay is almost 5 days.

However, you still can dodge the frequent mistakes in radiology billing services by familiarizing yourself with them at the outset.

6 Frequent Radiology Billing Mistakes to Avoid

1) Lack of prior authorization:

Generally, radiology practices require prior authorization approval from insurance companies for most of the advanced imaging procedures like PET scans, nuclear cardiology services, CT scans, nuclear medicine studies, MRAs, and MRIs. Before scheduling an imaging procedure, the provider is responsible for properly completing the prior authorization process. Lack of prior authorization approval can cause claim rejections and out-of-pocket expenses for your patients. To get reimbursed, the prior authorization needs to meet a few key requirements: it must be backed by medical necessity, billed by the provider listed in the authorization, and billed on time. All these conditions must be met to receive reimbursement. The truth is that every insurance company has its respective set of PA rules and policies. Insurance companies frequently expand their list of imaging procedures that require prior authorization, thus requiring your practice to stay on top of all the prior authorization policies to avoid denials.

2) Incomplete imaging report:

American College of Radiology requires you to include the following information to ensure a complete imaging report for the billing process:

• Description of exam, sequences, and/or technique
• Exam name
• Physician’s signature
• Comparison studies, if applicable
• Clinical indication/reason for the exam
• Findings
• Conclusion and recommendations, if directed

Missing any of this information in your report can lead to payment delays and a hampered cash flow. Make sure your administrative team pays meticulous attention to this information.

3) Incomplete claim information:

Accurate information plays a crucial role in the radiology billing process. Incomplete information always welcomes denied claims. Missing any of the information mentioned below could cause denials.

• Patient identification and group number
• Ordering care provider’s name
• Patient phone number
• Ordering care provider’s email address
• National Provider Identifier number
• Patient’s date of birth
• Ordering care provider’s mailing address
• Ordering care provider’s phone and fax number
• Patient name
• Patient address
• Ordering care provider’s tax number

4) Termination of services or exclusion:

Your administrative team must understand a patient’s insurance plan and if it covers the services you are going to provide.  It is important to review a patient’s insurance eligibility before providing imaging services. Check if the patient’s insurance plan has already been terminated or if it has already met the maximum benefits of coverage. Failing to perform insurance eligibility verification can lead your practice to encounter claim rejections and out-of-pocket expenses for your patients.

5) Inaccurate coding:

Inaccurate coding is one of the major reasons behind claim denials. Radiology is a vast process, involving thousands of imaging procedures and diagnoses. Each procedure and diagnosis has a specific code and your coding team needs to navigate through thousands of radiology codes to pick the right ones, along with accurate modifiers. Some of the commonly used radiology codes are:

CPT Codes (Current Procedural Terminology):

• 71045: Chest X-ray, single view
• 71046: Chest X-ray, two views
• 74177: CT scan of the abdomen and pelvis with contrast
• 70553: MRI of the brain with contrast
• 76856: Ultrasound, abdominal, complete

ICD-10 Codes (International Classification of Diseases, 10th Revision):

• R91.1: Solitary pulmonary nodule
• M54.5: Low back pain
• I63.9: Cerebral infarction, unspecified
• N18.3: Chronic kidney disease, stage 3

Apart from the codes mentioned above, modifiers 26 and TC are frequently used in a radiology billing and coding process.

Read More:

How Errors in Radiology Billing Impact Your Revenue Cycle

Billing errors in radiology can lead to costly delays and denials. Discover the top mistakes and how to prevent them. Read to learn more.

6) Poor denial management process:

Implementing a poor denial management process often causes an increased volume of accounts receivable, interrupted cash flow, and massive revenue leakage. Having a robust denial management process is critical for your radiology billing services as it ensures that denied claims are addressed and resolved accordingly. Your denial management steps should involve the following steps-

• Identifying denials
• Analyzing the denial reasons
• Correcting and resubmitting denied claims
• Following up

Unfortunately, the majority of radiology practices do not have an experienced billing team that can mitigate all these challenges. To avoid all the cost, time and hassles of recruiting an in-house team from scratch, radiology practices have started outsourcing their billing jobs to reputable RCM companies like Sunknowledge.

Sunknowledge Services offers top-notch radiology billing, prior authorization, and coding solutions. As a HIPAA-compliant and ISO 27001:2013 certified company, we handle all your billing needs, from pre-authorization to denial management and accounts receivable recovery. Our services come with no installation or training fees, making it easy to integrate us into your operations.

Our expertise can cut your collection costs by 80% and boost your collections by 97%. We pride ourselves on providing seamless account management and smooth business transitions. Choose Sunknowledge Services to handle your radiology billing and coding needs efficiently and effectively.