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Radiology Billing – Here Is Everything You Need To Know About It

Introduction

Most radiologists enjoy their jobs. However, they dread and try to avoid the back-end tasks that they consider very cumbersome – the billing and reimbursements. Some radiologists and healthcare providers try and handle medical billing and coding, and reimbursements all by themselves. In such cases, they will need to spend considerable money and effort in training employees, keeping track of compliance changes, and competing with similar hospitals and clinics.

According to experts, for every 1,000 procedures you perform, more than 1,000 Current Procedural Terminology (CPT) procedures need to be identified, and an equal number of ICD-10 diagnosis codes need to be applied. These definitely add to the complications of radiology billing and coding. Apart from these, there are so many other factors to consider and compliances to keep in mind while processing radiology bills.

There are different components of radiology coding, including X-Ray, Fluoroscopy, Computed Tomography, Magnetic Resonance Imaging, and Nuclear Medicine.

The pain points with radiology billing

Piling up the administrative burden

Radiologists work most part of the day and need to be available anytime for emergency diagnoses. Asking the doctor or their already struggling team to handle the administrative part is unfair and will not work in the long run. Even an expert medical billing and coding company, if slack for a couple of weeks, will be facing piled up unclaimed bills and excessive pressure from the client to get reimbursements done.

Quintessence had coded 2 million radiology charts for the month of January 2022! Our experts are adept at handling large volumes of bills and codes easily, making us a preferred choice with radiology clients.

A constant struggle to remain profitable

Falling reimbursement rates and increased business costs both have caused a dent in the profit margins, and this is something all radiology experts – in individual clinics and in large hospitals are facing. Even the slightest miss in radiology medical billing and coding can worsen the current state and cause a further dip in the profits.

Technological gaps

This is something that needs to be seriously discussed. RCM service providers who still depend on manual coding and claims go through problems like human error, slow processing rates, and an inefficient process management system.

Quintessence’s CAC coding platform has a separate in-built tool for radiology, and this is designed to handle the large volumes of complex claims that need to be handled right. Our tools are precise, have no room for error, and help automate most medical billing and coding processes, advising on the right modifier for the right situation and helping billers make the right decision.

Tips to improve radiology billing and coding

  • Start with the basics.

All reports need to have basic details and information in place. This is the quickest way a report claimed for reimbursement can be denied. Some of the basic details include the heading, number of views, the reason for examination (clinical indication), findings, synopsis, physician signature, and supporting films.

  • Know the CPT codes well

This is one of the basic needs to ensure your radiology billing and coding is approached right. Here is a list of typical CPT codes to keep note of.

70010 – 76499

Diagnostic Imaging

76506 – 76999

Diagnostic Ultrasound

77001 – 77022

Radiologic Guidance

77046 – 77067

Breast Mammography

77071 – 77086

Bone or joint Diagnostic Studies

77261 – 77799

Radiation Oncology

78012 – 79999

Nuclear Medicine

  • Check and verify

Make sure you check and verify the number of views on the report. If the healthcare provider does not provide the correct number of views, getting a full claim on the bills will not be easy. Reports that don’t carry the minimum number of views are quickly denied reimbursements.

  • Differentiating professional, technical, and global components

Always ensure the professional, technical, and global components are understood and separated.

  • The professional component includes the service of the professional in providing the report. If you want to report just the professional component, then you may have to add the modifier 26 Professional component to the code.
  • The technical component includes all the equipment used, personnel involved, supplies used, and other costs relating to performing the examination. If you want to report just the technical component, then you may have to add the modifier TC Technical Component to the code.
  • The global component occurs when the physician bears the cost of the equipment and supplies and also plays a role in preparing the report. This is a common occurrence in laboratory settings where the doctor owns the equipment. In this case, you may not need to use the TC and 26 modifiers
  • Documentation

Make sure the healthcare provider’s documentation is complete. Many cases of denials happen when the radiologist fails to provide the required image documentation. Different types of scans require different views of images, and if these are not included, the claims cannot be processed.

For instance, a complete abdomen study (CPT Code 76700) will require images of the bile ducts, gall bladder, liver, pancreas, kidneys, spleen, inferior vena cava, and upper abdominal aorta. Even if one of these documents goes missing, the claim cannot be processed. You will now have to get back to the health provider for the addition of documentation or change the coding to make this a limited exam.

We understand that such small hassles can extend the payout cycle and lead to serious revenue troubles over time. That is why we have invested in the Doctor’s Portal that is offered free to all our clients. The portal helps get in touch with the radiologist by raising tickets and requesting additional documentation and data directly, without waiting in vain.

This saves our medical billing and coding experts precious time and helps process claims quickly and with the right information in hand.

Conclusion

How effective is your current radiology billing process? How often do claims get denied and rejected due to lack of right data, human coding error, and other preventable causes? Radiology medical billing and coding services offered by experts like Quintessence can help reduce coding errors and help improve your reimbursement rate. Our tools and services are designed to identify loopholes in the current process and act upon issues that could lead to more significant problems in the future.

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