Stay Uncompromised With Outsourced Radiology Billing Solutions

Delayed payments, coding errors and unresolved denials can affect a radiology practice’s cash flow. In fact, most radiologists struggle with documenting their billing affairs and other paperwork while providing imaging services. As multiple imaging tests be it as X-rays, MRIs or even CT scans all are conducted to diagnose patients and itemizing them can be overwhelming. Each imaging procedure requires a specific set of medical codes for the claim reimbursement process. These claims, if not reimbursed, affect the revenue generation of the provider and impact the growth of the business. And thus, providers need a reliable radiology billing solution to submit accurate claims and unpaid balances.

Moreover, not only reduces the operational burden and accelerates claim reimbursement but also enhances patient care. Before we go ahead and discuss how these companies operate, it is important to know what these companies are.

What are outsourced radiology billing companies?

On a daily basis, being a radiologist you are involved in dealing with imaging services for patients, which include X-rays, MRIs, and CT scans. Your priority is to ensure patients get what they are looking for without any issues. Problems may start to occur when you submit claims for these services but do not receive payments on time. In some cases, you may also receive partial payments that can sometimes become an underpaid claim too. Providers hire a specialized radiology billing company that ensures services are reimbursed efficiently

An outsourced billing company has trained staff and certified coders who are skilled at handling all kinds of radiology reimbursement issues. These companies perform the necessary actions from patient registration to payment posting. When your clinics struggle with increasing patient volume, relying only on the in-house staff may not be sufficient. Taking the support of these third-party radiology billing services can reduce errors and improve collection rates more effectively. 

Let us assume that your in-house billing team has trained staff and can handle a large number of claims. Complexities start to arise when the rate of denials increases at an unexpected rate. The existing staff may feel overburdened, which can significantly impact their productivity. This is when an external billing company can be the best choice to provide the required support to your practice. Now the question remains is why should providers hire external billing companies? Is it only because of underpaid claims or high denial rates? This brings us to the reasons behind radiology billing outsourcing, which include the major challenges in imaging center reimbursement.

Understanding the major challenges in Radiology Billing

Submitting insurance claims does not guarantee reimbursement in any healthcare billing. Billers have to ensure accuracy in various departments such as documentation, coding, and prior authorization. As a result, the following challenges occur in imaging center billing that affect revenue growth.

Multiple coding variations – These include diagnostic imaging billing services like MRI, CT scan, ultrasound, and X-rays. Each of these tests has specific coding requirements and multiple applications. A coder who fails to track these coding variations might miss out on implementing the correct code. This could lead to underbilling or claim denials, further affecting revenue generation.

Complex CPT codes – The CPT codes for radiology undergo updates. Even minor updates to codes and bundling rules lead to major changes in the reimbursement process. The codes are differentiated by whether the scan was done without contrast or with contrast in the same session. Also, brain scans and spine regions require distinguishing whether it was cervical, thoracic, or lumbar, and require distinct codes depending on the use of contrast. This lack of knowledge of updated coding rules is another reason for frequent errors in radiology billing.

Higher denial rates – Claims are denied mostly due to incorrect coding or lack of adherence to payer policies and healthcare regulations. If clinics are facing higher denial rates, it means that insurance companies reject a larger percentage of submitted claims. Payers can reject claims if there are any issues with medical necessity, prior authorization, incorrect coding, or payer-specific requirements.

Detailed documentation requirements – Patient A may have different policies than patient B, where both of them undergo a CT scan. Most in-house staff find it difficult to adhere to different payer documentation requirements. This is when errors occur, and radiologists do not receive the expected reimbursement. Sufficient clinical information is required to verify that a service was necessary.

Related Reading: Signs You Need to Switch to a Radiology Billing Company

Common radiology procedures and their billing issues

Whenever we talk about radiology procedures, we think of X-rays, MRIs, and CT scans. These are the most frequently used radiology procedures and have specific billing requirements. Let us discuss how each imaging test can be challenging in radiology reimbursement.

1. X-rays

Selecting the wrong CPT codes is very common in X-ray claim submissions. The codes vary depending on the anatomical area, type of examination, and number of views. The CPT code 71045 is used to represent a single-view chest X-ray, whereas the code 71046 is used for a two-view chest X-ray. There are high chances of claim denial if the code does not match the documentation.

2. CT scans

Contrast material is an important factor in CT scan billing. This is mainly because CPT codes differ depending on whether the examination is performed with or without contrast. Billing issues become frequent whenever the coding team selects an incorrect contrast-related CPT code.

3. MRI

Prior authorization is required by many insurance companies before approving an MRI examination. There are high chances that the claim may be denied if the MRI is performed without obtaining it Authorization problems can also occur when the approved body part, diagnosis, or procedure does not match the service performed.

The role of expert billing professionals in rectifying errors

The frequent errors in radiology billing can be avoided by hiring professional radiology billing solutions. These outsourced companies improve overall revenue cycle management in the following ways:

Improve clean claim rates – This is one of the most important ways outsourced radiology billing companies help imaging centers, hospitals, and radiology practices improve their revenue cycle management (RCM). Claims are submitted to insurance companies with accurate information and the required billing details. Identifying and correcting errors before submission becomes more convenient because of trained billers and expert coders. Additionally, a radiology billing outsourcing company also confirms the application of correct codes for imaging procedures.

Trained staff – The third-party companies have trained billers who have expertise in radiology coding services. Their knowledge of complex bundling rules and imaging techniques prevents errors that may arise in the billing process. They select appropriate codes based on clinical documentation and understand the differences between professional and technical components. Trained staff understand when to use modifiers for professional components and technical components.

Real-time claim scrubbing – Outsourced radiology billing companies apply this process to identify and correct errors before claim submission. With real-time claim scrubbing, identifying errors and correcting claims becomes more convenient for outsourced companies. Real-time claim scrubbing automatically checks CPT codes for imaging procedures.

Strengthen accounts receivable (AR) management – Outsourced companies employ dedicated AR specialists who perform the following tasks:

• Continuously monitor unpaid claims
• Follow up with insurance companies
• Collect outstanding balances.

These specialists are involved in regularly reviewing claims that have not been paid by insurers. They also prioritize older outstanding claims to delay the cash flow.

Use of advanced technology – This is one of the major advantages of hiring a professional radiology billing company. Most third-party companies use updated software and artificial intelligence (AI) to streamline billing operations. Radiology involves dealing with a large volume of claims. It is a challenging task to manage these claims manually where there are high chances of errors. As a result, claims can be denied, and reimbursement can be delayed. With the help of electronic claim submission, billing teams can eliminate the manual paperwork involved in claim submission. The application of AI helps prioritize claims that require additional attention. In this way, providers can reduce aging AR and recover outstanding payments.

Besides these benefits, there are other ways in which professional radiology billing solutions improve your revenue generation. However, to ensure optimum efficiency of billing operations, it is important for you to verify a few factors before outsourcing. This will not only ensure that the reimbursement rate increases but also that patient security is not compromised.

Related Reading: Prior Authorization in Radiology Billing: How to Reduce Denials

Key indicators of a reliable radiology billing company

A company that will perform all the necessary steps for billing will have better operational efficiency in the market, when compared to other billing companies. Thus, it is important to keep in mind the following factors before partnering with an expert radiology medical billing solution.

Industry experience – Radiologists deal with multiple equipment for X-rays, MRIs, and ultrasounds. It is an important indicator of reliability because radiology billing is more specialized than general medical billing. Companies require an understanding of the following:

• Diagnostic imaging procedures
• Complex coding requirements
• Insurance policies
• Payer-specific reimbursement rules

Experienced radiology billing solutions understand the details of handling Medicare and Medicaid insurance policies. This makes it convenient for them to submit claims for patients covered by Medicare or Medicaid.

Connecting with other clients – A reliable billing company will provide references to their clients with whom they have previously worked. The radiologists or providers can connect with these clients to have a better understanding of the company’s services. Clients can provide a clear explanation of how effectively the billing company handles inquiries and communicates important updates.

Understanding professional, technical, and global billing components – Technical factors include all the supplies and equipment used in performing the particular test. As global billing combines both the professional and technical components and so the billing provider is entitled to bill both. While for the global component, the physician contributes significantly to the report generation and bears the associated equipment and supply costs. Experienced radiology billing solutions must have knowledge of both technical and professional components to ensure improved accuracy.

 Specialized support and communication – A professional radiology billing service ensures clear communication with the insurance company and the radiologists. This enhanced communication creates specialized support for the providers in fulfilling their billing requirements.

It is difficult but not impossible to get all these benefits from a billing company. SunKnowledge offers the best radiology billing solutions to all your major reimbursement issues. There are reasons why partnering with us can transform your overall revenue cycle management.

How can SunKnowledge be your best choice for radiology billing?

Radiology specialists work with a variety of medical equipment and the services associated with it that requires different codes and conditions for claim reimbursement. As a result, the medical imaging reimbursement process becomes difficult for the in-house billing teams. SunKnowlegde offers an overall first-pass claim submission rate of 97% and charges only 2% of collections from AR and denial management. Our CPC-certified coders ensure that services are coded accurately so that you receive proper reimbursement.

What’s more interesting is that our dedicated account managers are available to address specific issues in your imaging center billing. Our virtual assistant support services, including appointment scheduling, responding to patient inquiries, and managing voicemails, enhance remote patient support within your practice. We not only offer tailored radiology billing solutions but also ensure that your patient data is protected from potential cyber-attacks. Contact our experts to get optimum results in your radiology practice.

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