5 Radiology Billing Errors That Lead to Revenue Drain!
Our healthcare system is still reeling under the economic and operational pressures that the Covid-19 pandemic had brought in its wake. For radiology practices, the economic stress of the pandemic has been particularly severe. Examination volumes have gone down, rules have changed and revenues have started to dwindle. A special report from the RSNA Covid-19 task force has revealed that the drop in examination volumes for some private radiology practices in the last year has been higher than 80 percent!
While the economy is slowly edging back to normal, the threats of a second and third wave loom large over the horizon spelling low profitability for radiology departments and imaging centers. In these challenging times, it is utterly crucial for radiology practices to re-focus on revenue cycle efficiency. This is definitely not the time to leave money on the table for any reason, especially for mistakes that could be avoided!
Here are five common radiology billing mistakes that if avoided, can considerably improve your reimbursements.
1. Lack of Pre- Authorization
Payers keep continually extending the list of procedures that need pre-authorization. So before scheduling the procedure, the imaging care provider must take care to review or request pre-authorization from the healthcare provider. Payers have mandated that the prior authorization has to be supported by medical requirements, charged by the provider listed in authorization or suggestion, on time. If any of these requirements are not met, the claim can be denied. Sometimes a provider may have to alter the course of treatment suddenly and end up ordering a different procedure than what was originally authorized. A professional RCM service provider with trained personnel can ensure that every service that needs pre-authorization has the authorization number received and documented clearly.
2. Incorrect diagnoses
Automated coding solutions or billing departments using coding software quite often mistakenly code a wrong diagnosis that a physician made a mention of in his notes as just a possibility in the initial stages. Well-experienced coding teams with adequate experience are more likely to know all the nuances in the way a physician may arrive at a diagnosis than tools programmed on NLP techniques.
3. Inaccurate Coding
Another big challenge of Radiology billing is the constantly updated codes. In 2021 Current Procedural Terminology (CPT) revisions mainly include the overhaul of the Evaluation and Management section, reduction of documentation requirements, and introduction of new rules for determining the level of coding. Keeping track of these changes is important for maintaining coding accuracy. Incorporating Coding audits in the RCM process that are performed by certified coders with specialization in the radiology domain can ensure that the coding quality is high thereby reimbursements are collected on time.
4. Incomplete Documentation & Imaging Reports
An imaging report must necessarily contain all this information to be complete
- Exam name
- Description of exam and technique
- Physician’s signature
- Comparison studies if applicable
- Clinical indication/reason for the exam
- Conclusion and recommendations, if directed
When your radiologists do not properly document complete procedures, your practice can lose anywhere between 20-50% of the potential reimbursement.
5. Not Capturing Patient Information Correctly
Recording patient’s information incorrectly is another most common billing mistake that leads to denials and rejections. Apart from basic information about the patient like the name, date of birth, and sex, billers must ensure that the policy number and payer name are entered accurately. A system to verify if the group number is mentioned if the particular type of claim requires it, the diagnosis code matches the procedure offered and if the relationship of the patient to the insured is precisely recorded will prevent a good number of denials.
These challenges can be too cumbersome to keep up with for practices focused on care quality. Rannsolve offers dedicated professionals who keep a tab on all radiology coding and billing updates, ensure that you sidestep these common pitfalls, and maximize your reimbursement rates. With our intensive experience in billing for the Radiology domain, we have developed a deep understanding of the struggles and unique needs of radiology and imaging service providers and fine-tuned our solutions and processes to address those needs.
As uncertainties seem to cloud the future of healthcare, the most commonsensical solution for Radiology practices to sustain themselves through these turbulent times will be to reap the benefits of entrusting your RCM to a reliable partner. Get in touch with us today to learn more about our services.