The high volume of test and precise documentation requirement makes the coding and billing of radiology practice more difficult than in other disciplines. The primary purpose of radiology physician is to receive reimbursement rapidly. It is critical to guarantee that claims for services are submitted on time and to collect reimbursement as soon as possible. That will improve the practice’s cash flow and also reduce overall billing costs to a minimum. Let us look at the reasons behind radiology claim denials:
Patient Eligibility Issues
Claims denials due to patient eligibility mistakes are a concern for radiology professionals. These include reporting the wrong insurance company (or plan) data on the claim, listing the wrong service site, and having demographic difficulties during registration. The ideal way to solve this problem is to use insurance eligibility verification services. Medicare and commercial insurance companies will reimburse only claims containing reliable information about the patient’s eligibility for coverage. Any discrepancy along the way will result in a claim denial, with the claim being redirected to the radiology group to be corrected.
Do Not Get Proper Authorization For The Process
Prior authorization is necessary by many insurance plans for imaging procedures, and the introduction of ICD-10 diagnosis coding has raised the amount of precision needed in the preauthorization procedure. Doing these services without prior authorization will result in a denial. Claims will also be denied if there is a difference between the authorization and the exams performed. Radiologists should know which processes and examinations require preauthorization and inform patients when they set up an appointment or arrive for the test.
Fail To Verify The Medical Necessity
Medical procedures determine the circumstances under which specific processes must be performed. The physician must ensure that any test is medically appropriate to diagnose and treat the patient’s condition. Denials of claims for medical necessity are typically the result of information transmitted to the insurance payer instead of the doctor’s patient care choices. It is critical to have good documentation to support the purpose of the exam, such as details from the patient’s condition.
Controlling Radiology Claims Denials
A radiology practice must consider the following factors to minimize denials. For example, practices must find the source of denials and ensure that no data entry errors occur during registration. Creating clean claims begins with forwarded assembling reliable information and ensuring that the claims are accurate and complete. A dedicated staff member should handle coordination and verification of authorizations. The consultation should be rescheduled if authorization cannot be procured in time to prevent an insurance denial. Train your staff to collect as much thorough patient and insurance data as possible. Ensure that the registration staff has enough information and can question the patient when they arrive for the exam. Maintain an up-to-date technologist worksheet with specific questions about history, signs, and symptoms. Recognize which exams must be investigated and make sure to provide complete and accurate information for these tests. Make sure that the medical need and documentation both should be handled effectively.
Hire Best Medical Billing Service Provider To Prevent Radiology Claim Denials
A competent medical billing firm would actively handle claim denials and give superior solutions. They track denial reports and take action on any irregularities that appear. Examine denials and determine when an appeal is necessary. They follow-up on radiology denials daily and keep their patients informed of the practice’s plans. Want to know more about how your practice can reduce radiology claim denials to improve cash flow and streamline preauthorization workflows for hospitals, clinics, imaging centers, and laboratories for different specialties? Contact us today and visit our LinkedIn profile to stay updated on company and business developments.