The coding and billing process in a radiology practice is often more cumbersome than other specialties; not only is there a high volume of examinations, the documentation requirements are very detailed and precise. According to a study by the Radiology Business Management Association, the industry standard denial rate for radiology practices is nearly 30%—and radiologists collect just 79% of the revenue they’ve earned. To top it off, it costs about $30 on average to work a denied radiology claim.
Those statistics highlight the importance of taking proactive steps to minimize the number of denials and write-offs on the front end. And even if you outsource your radiology billing, there are things you can do in your practice to improve financial outcomes.
ABNs are extremely important in a freestanding imaging center.
The advanced beneficiary notice protects you when there’s a possibility you won’t get paid for a procedure, typically on medical necessity grounds. You should definitely get ABNs on all mammograms for Medicare patients and on obstetrical ultrasounds unless medical necessity is clearly specified. If you outsource, work with your billing company to implement a process for transmitting copies of the ABNs. Look for trends among referring providers, as well: Make sure they know which diagnoses are covered for particular procedures. And remember, if the ABN isn’t signed, it’s an automatic write-off.
Know the current documentation requirements for all CPT codes.
Make sure you review your report templates once a year at a minimum to be sure all titles are up to date and the correct technique verbiage are included. If you change equipment or technique, update your templates to reflect the changes. Be sure to notify your billing department or outsourced agency when protocol changes occur; they can act as a secondary check that documentation is correct.
These steps prevent the need to go back and add or change information to the report in the event of a denial. Make it a priority to seek feedback from your billing company or department on a monthly basis to make sure documentation is adequate or if there are opportunities to improve. They are usually in the best position to spot trends that affect reimbursement.
Implement a policy to identify and address report discrepancies.
The sheer volume of exams means that errors and discrepancies (number of views, right versus left, etc.) are going to occur—but it’s essential to have a formal policy for handling them. Be sure that the staff handling the dictation and the billing staff have a clear path of communication and know the steps to take once a potential error or discrepancy is identified. Task someone on the team with ultimate responsibility for following up on each discrepancy; catching them on the front end before they reach the payer is far more cost effective than handling a denied claim later on.
Don’t forget to check for pre-authorization requirements.
Radiologists are “blind” providers, in that they are dependent upon the referring physician and, if they are hospital-based, the facility, in order to get paid. If a patient presents for an exam that requires prior authorization and the referring provider or hospital hasn’t obtained it, the radiologist is essentially working for free.
Find out which procedures and exams require precertification and train registration staff to be alert to those procedures and inform the patient that’s it’s required when they make an appointment or arrive for the exam. Ask your billing staff or outsourced billing company to provide you with regular reports on write-offs due to precertification and the referring doctors who order them. If one provider is consistently failing to obtain preauthorization, reach out and ask for cooperation.
In an environment of ever-decreasing reimbursements, it’s essential to minimize denials and collect all the revenue you’ve earned. Contact the radiology billing experts at M-Scribe today for a free consultation to help you improve your bottom line.