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Mistakes in Radiology Billing That Impact Reimbursement

Mistakes in Radiology Billing That Impact Reimbursement
It’s important to maintain proper documentation and take the time to avoid these common radiology billing mistakes that can have an impact on reimbursement.

During radiology billing reimbursement, many challenges can come about. Claim rejection can be disappointing, and extend the timeline you’re working on. In recent years, imaging centers have seen an increase in prior authorization declinations. 

With the rising number of processes requiring authorization, so many imaging centers around the country are dealing with more and more radiology billing mistakes that bog everyone down. It’s important to maintain proper documentation and take the time to avoid these common radiology billing mistakes that can have an impact on reimbursement.

No Prior Authorization

It’s typical for insurance companies to require prior authorization, especially when we’re talking about advanced outpatient imaging procedures. This includes CT scans, MRAs, MRIs, nuclear medicine studies, nuclear cardiology services, and PET scans. Before any of these image procedures are scheduled, it may benefit the imaging care provider to contact the payer and attain prior authorization to avoid any potential radiology billing mistakes.

Missing Imaging Report

One requirement in place by the American College of Radiology is that imaging reports are complete with all of the necessary information, including a description of the exam, sequences, and/or technique; physician’s signature; comparable studies whenever applicable; findings; the clinical reason behind the exam; exam name; conclusions and recommendations. Missing any of these components can lead to radiology billing mistakes and delays.

Incomplete Claim Info

It’s critical that accuracy is paid special attention to during these processes. If you end up with incomplete information during the billing process, you may end up delaying something or having an outright rejection of service. Here are some details to pay attention to; patient ID & group number; care provider’s name; patient phone number; care provider’s email; National Provider Identifier number; patient DOB; mailing address and phone number for care provider; patient name and address.

Incorrect Patient Info

Even worse than missing info is incorrect info. If timely payment is to be delivered, remember to enter all patient details correctly, including their name, birth date, and sex. You also want to pay close attention to the proper insurance payer and the reviewing policy number. Take the extra step to compare and see whether a specific claim requires a group number and if the diagnosis code matches the procedure being done. If there are multiple insurances at play, check to see that the primary insurance is the one listed.

Uncovered or Terminated Services

Familiarity with a patient’s insurance plan, matched with knowledge of your services, is critical. Review whether the patient is eligible for the services provided, especially since insurance info is constantly changing on us. You want to crosscheck something like termination of coverage if the maximum benefit of the cover isn’t met. Take time to review a patient’s insurance information and prevent any rejections or delays in reimbursement.

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This entry was posted on Tuesday, May 24th, 2022 at 3:56 pm. Both comments and pings are currently closed.