In recent years, technological developments in radiology have been truly astounding, but the necessary high-tech equipment and specialized supplies involved have led to costs rising rapidly—making the specialization a target for private insurers and federal programs looking to cut their costs.
The transition from fee-for-service to bundled payments has only been made more complex by all the different policies and practices involved with accountable care organisations and pay-for-performance and value-based models.
Radiology is the highest profit-generating department in hospitals, being responsible for 37 percent of profits on average, according to The Advisory Board Company, so chances are the future contains even more scrutiny and efforts to cut down on amounts payed out by insurers and other payers.
The Radiology Department’s Medical Billing Challenges
Because radiology is primarily a referral-based service, the trend towards more bundled charges and grouped providers is complicating and slowing down radiology medical billing. Efficient revenue cycle management (RCM) depends on radiology billing services that code properly and submit claims quickly. Another integral part of this system is receiving payments and swiftly handling rejected and denied claims.
Denied and rejected claims occur when even the slightest error is made in coding and data entry. Payers do not take the time to consider whether an error is insignificant and even a missing hyphen or misspelled name is enough to get a claim denied. Payers even deny claims in bulk when there are errors with submissions. Each claim must be reprocessed, taking up valuable staff time to sort out the error and correct it, resulting in increased labor costs.
In many cases, the problem with a claim is brought to the attention of department staff when a patient calls to complain about being billed for higher charges than they were expecting, which not only requires more staff time to handle, but also results in a patient who feels their trust has been violated. On top of all that, payers also have requirements about claims being timely, and all the back and forth of trying to get it right can result in missing a deadline.
The three most common reasons for claim denials noted by radiology RCM experts are:
Patients’ insurance eligibility issues—listing the site of service incorrectly or noting the wrong insurer or plan number are common examples.
Failure to obtain authorization for reimbursement
Omitted documentation demonstrating medical necessity reimbursement
The Solution to Your Radiology Billing Problems
Human error is the cause of the majority of claim denials and rejections described above. With all the complexities of the payers’ rules and billing models changing, in addition to the annual changes made to the medical billing codes, it has become impossible for a busy medical staff to stay on top of it all. The answer is to outsource to an experienced radiology billing service so that you can save your time and attention for your actual job—providing radiology services to patients and all that that service requires.
Medcare MSO handles all phases of medical revenue cycle management from pre-appointment to past-due accounts receivables. We have medical billing and coding specialists on staff who are experienced with the specific needs of radiology, and since medical billing is all we do, we are able to stay up to date on changes in the field and provide software that is up to date with all the latest codes and requirements.
Our customers include the gamut from small private practices to large hospitals, and they tell us that paying a small percent of payments received for our services has increased their overall profits and made running their practices much more efficient.
Get a free demo today and see how we can help you and your practice run more efficiently.