The radiology department in healthcare deals with X-rays and other high radiation rays to treat different diseases. Every time you need an internal health cure that involves rays, radiology will be your only spot. So the billing process conducted by the staff working in this department is known as radiology medical billing. Here we will dive into what radiology billing is and how you can generate more revenue by following proven strategies and avoiding the mistakes that clearly lead to claim denials.
The Process Of Radiology Medical Billing
Like a normal medical billing procedure, radiology departments contain the same steps that lead to revenue generation at the end. This requires a struggle of 7 steps with each connected with one another. Let us go you through the radiology medical billing process that will help you understand the complexity of this intricate healthcare operation.
Patient Registration
When a patient visits the hospital or asks for the schedule even on the phone, they are assisted. Here staff collects all the basic information from the patient including their insurance coverage.
Pre-Authorization
Once insurance details are obtained, staff contact the insurance payer and confirm the patient’s eligibility to receive the services paid by their coverages. This step ensures revenue anticipation and prevents future financial issues faced by patients.
Healthcare Treatment
Once patients visit the hospital for proper care, their further details are gathered. They then receive healthcare treatment. During the entire radiology medical billing process, each single service and equipment used is listed.
Code Capture
The listed medical services and supplies are then translated into codes (which is a common language in healthcare, used to interpret rendered services and supplies employed during the process).
Claim Application
Then these codes are used to create claim applications which are then sent to the insurance payers. The codes we talked about in the last heading are actually useful here because insurance companies use these codes to translate services and equipment and it helps them calculate the total amount they have to pay.
Reimbursement
After carefully reviewing the claim application and supporting document, if they are satisfied they will release the payment. If they are not, then you will have to recreate and appeal the claim. Don’t worry, you have multiple chances of approval.
Medical Bill
The final stage of radiology medical billing is where some payable costs have to be collected from the patients. Even after the insurance they have to pay the bill, so when they make it, the process is completed.
This shows how each step is laid by the preceding one and creates a base for the following one. So if you put serious effort into each step, you surely will get productive results in the end.
Common Codes Used In Radiology
Radiology medical billing runs on codes. You can’t neglect the fact that in order to learn billing, you must know the basic codes used for certain types of procedures and treatments. Without coding, medical billing is just like a boat without oars. So talking about radiology, here are a few of the hundreds following codes that are used by healthcare professionals to capture services and create claim applications.
X-ray Procedures
- Chest X-ray (CPT code: 71010)
- Abdominal X-ray (CPT code: 74000)
- Extremity X-ray (CPT code: 73000)
- Spinal X-ray, three views (CPT code: 72050)
- Dental X-rays, complete series (CPT code: 21085)
Magnetic Resonance Imaging (MRI)
- MRI of the Brain without Contrast (CPT code: 70551)
- MRI of the Spine without Contrast (CPT code: 72148)
- MRI of the Knee with Contrast (CPT code: 73721)
- MRI of the Shoulder without and with Contrast (CPT code: 73221)
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Computed Tomography (CT) Scans
- CT Scan of the Head without Contrast (CPT code: 70450)
- CT Scan of the Abdomen and Pelvis with Contrast (CPT code: 74177)
- CT Scan of the Chest with Contrast (CPT code: 71260)
- CT Scan of the Sinuses without Contrast (CPT code: 70486)
Ultrasound Procedures
- Abdominal Ultrasound (CPT code: 76700)
- Pelvic Ultrasound (CPT code: 76856)
- Obstetrical Ultrasound (CPT code: 76805)
- Thyroid Ultrasound (CPT code: 76536)
Nuclear Medicine Procedures
- Bone Scan, whole body (CPT code: 78306)
- Thyroid Uptake and Scan (CPT code: 78012)
- Cardiac PET Scan (CPT code: 78459)
- Gastric Emptying Study (CPT code: 78264)
Documentation Tips For Quick Claim Approval
One thing that haunts billers and coders alike is the rejection of claim applications. After all, we are all humans and we make mistakes, this leads to multiple claim denials including hundreds of errors and loss of revenue. Documentation plays a crucial role here. If you haven’t listed the services and codes well, then how are you going to get your revenue? So if you want your claims to be approved quickly for radiology medical billing, here are some tips to look at:
Proper Pre-authorization
Remember we talked about contacting insurance companies early on for the patients? Here we are talking about asking them if they need any documents before the treatment. Some payers demand pre-approval before beginning the cure of the patient, so this step is crucial to perform if you don’t want straightforward claim rejection.
Check Insurance Coverage
When you contact insurance payers make sure to ask them about the expected treatments a patient is going to receive. This will help you know what services come under their coverage and what patients have to pay. You must also make patients aware of their owed out-of-pocket amount, so they could ask for financial help early on.
Document Medical Necessity Clearly
During radiology medical billing, you must mention every small to big medical procedure and service in the patient’s medical record. Clearly define the medical history, symptoms, and improvement to show the necessity of the treatment given.
Stay Updated With Coding Changes
AMA constantly updated codes, leading to new codes coming up for services and old ones being deleted. So before beginning your coding, review the latest updates to ensure accurate billing. Catch up with resources that inform you about the codes to prevent inaccurate coding.
Monitor Claim Statuses
One thing that billers neglect during radiology medical billing is that they don’t pay attention to the sent claim applications. You don’t know how much revenue you are losing just because you didn’t track its status. When claiming your revenue, ensure your eyes are on whether it is approved or is it in the objection box. Constantly eliminate the payer objection and review the reclaims to see if they have been approved.
This way you know your weak points and what the common objections are that lead to claim denials, resulting in an efficient claim strategy and more perfect claim applications.
Follow-Up On Outstanding Claims
Pending claims if not paid attention lead to revenue loss. Implement a proper strategy to follow up with the insurance payers and find out the reasons for the delay. Communicating constantly with the payers will create an impact and they will instantly make the payment once your claim is cleaned from errors.
Provider-Payer Communication
Last but not least, keep a clear communication with the insurance payers. Regularly get the updates on your claim applications and eliminate inaccuracies early on. Building a positive and open relationship with them will benefit you in the long run, so keep your collaboration smooth.
Radiology Billing Essentials
Radiology medical billing isn’t a complicated process. All you need to know is the process, the cruciality of each step, and accurate codes to create claim applications. To boost your revenue generation, we have also mentioned some tips to fix your documentation. So this guide will serve as a base for your strongly built healthcare financial structure in radiology.