Tuesday, December 7, 2021

Challenges to Radiology Medical Billing Service & Practical Tips

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Challenges to Radiology Medical Billing Service

Unlike other medical practices, Radiology consists of two billing segments — the professional segment & the technical segment. When radiologists use a radiology device, dyes & machines, they should bill it under technical parts. However, when the radiologist evaluates the diagnostic results, they need to bill the service under the professional aspect. 

Radiology Medical Billing

The unique features of radiology medical billing services can be challenging for radiologists. It is a service that applies imaging procedures for both the diagnosis and prescription of disease. In addition, radiology has various distinctions due to its frequently growing advanced technology & treatment processes. Usually, there are new extensions to the CPT codes used for billing radiology services work, which obliges continual attention.

Decreasing reimbursement rates, increasing infrastructure expenses, and shifts in payer mix create challenges for radiology practices. As a result, it is more crucial than anything before to ensure that you can maximize reimbursements and maintain profits. 

Challenges to Radiology Medical Billing and Practical Tips

Below are the top 4 challenges for radiology billing services and tips to significantly improve your medical facility’s cash flow.

Administrative Load

Radiologists put a lot of weight on them by doing everything by themselves. It’s a big ask as they handle restless billing and coding duties as well as non-medical responsibilities. By taking all the tasks, they feel that they are administrating it in a better way. As a result, they spend less time focusing on providing quality medical care services. They think of an unnecessary load of managing both medical billing and medical care management. 

The administrative burden is not a new problem; several medical offices all around the United States have been facing these problems. As a result, there is a need to invent administrative responsibilities whether you are practicing on a large scale or individually.

In radiology billing, insurance firms are proposing new payment policies constantly, which could be an issue for practice owners to train their staff about the latest changes. Usually, radiology medical billing and coding needs a particular level of expertise and certified credential, which practice owners or their team might be missing. If you are running your practice considerably, things might be hard to control due to the administrative burden. Outsourcing your radiology billing services can take away your administrative responsibility and reduce your stress administrative burden. Your saved time can use in rendering quality radiology services. In addition to this, medical billing organizations help you focus on other core competencies of your medical facility remarkably. 

Claim Denials/ Rejections

Radiology specialists face substantial revenue loss due to rejected claims and denials. It would help if you had more time and extra effort to comply with changing regulations and evaluate exact details for the essential documentation before the correct submission of medical claims. It’s a challenge to streamline the claim submission process, decrease difficulties of payment denials, improve incapable payment schedules, and improve reimbursements without proper management and evaluation. Later, the costs included working on such denials and rejections also increased rapidly, putting more burden on the practice owners. Radiology medical billing specialists can support you in decreasing medical billing and coding errors, decreasing rejection of claims, submit clean claims, managing claim denials, and adhering to insurance guidelines.   

Therefore, when you hire granted medical billing organizations, billing professionals help healthcare practitioners to defeat billing/coding errors. And also focus on core practice operations, submit clean claims, reduce rejections/denials, better cash flow, adhere to insurance policies, and get paid on time.

Unqualified Staff

As I suggested beginning, radiology medical billing and coding needs certified and experienced billers and coders. Unfortunately, to have better control, many practice owners mistake selecting in-house billers and coders. As a result, they may not know the basic rules of radiology billing and make many mistakes that directly influence your insurance payment. In addition, your in-house staff may not settle on top of radiology medical coding or billing as they also have to work with administrative duties. 

Many medical practices have handed their billing and coding works to inexperienced and uncertified staff. Furthermore, practitioners find it hard to keep their team updated about the new medical coding and billing policies. Also, it is affecting the effectiveness of medical care professionals while delivering patient care services.

However, an expert medical billing company can help you to defeat these problems significantly. These medical billing organizations have certified and experienced radiology billers and coders with thorough industry experience and practice knowledge. Besides, they stay updated with the newest coding development and new rules of the billing system. They understand your business necessities and present practical solutions to improve the richness of your medical facility.

Reduction of Technology:

The present is the period of the latest and excellent technological change. But, unfortunately, traditional billing systems can enhance the chances of human mistakes. Without an incapable practice management system, it could become hard to stop the possibilities of costly errors.

Therefore, billing specialists use cloud-based technology and integrate EHR/EMR systems when outsourcing radiology billing services. They use excellent tools to automate the whole billing cycle efficiently. In addition, they use updated claim analytics tools that help you trace claim denials and rejections efficiently.

Furthermore, they assist you in recognizing the modern analytical trends and work towards improving your business productivity. They also give practical methods to enhance the ability of your business.

Outsource Medical Billing 

Medical practice doesn’t need to face these radiology billing and coding challenges alone. By outsourcing your radiology billing and coding, you can work with billing and coding experts, who have comprehensive knowledge about diagnostic radiology coding, and understand payer rules. They use correct codes to file claims and help practitioners to get reimbursed punctually. In this way, outsourcing companies improve the revenue stream and improve the cash flow.  

Medical claims must process with correct data. So, medical care professionals can get maximum payments for their radiology billing services.

However, medical billing is a critical and time-taking task. In addition, it can be an issue for some radiology practices as it includes a series of steps, and each effort relates to the previous step. Therefore, it is crucial to handle medical billing and coding procedures efficiently.

Reliable billing is vital to develop the healthcare revenue cycle management and decrease the account receivable days significantly.

Moreover, the redundancies of billing and coding systems can lead to billing/coding errors, claim denials/rejections, disordered RCM processes, and low payment collections. Therefore it can affect the effectiveness of the company.

Professional radiology medical billing experts cover conflict challenges like; increased administrative burden, inefficient staff, lack of technology, and claim rejections. They cover all from acceptability verification to clean submission of medical claims to revenue collections.

Radiologists need to be experts in diagnosing several diseases, monitoring the treatment, and predicting the outcome; besides, these experts play a crucial role in managing the IT applications for healthcare. However, it is pretty challenging to ensure appropriate reimbursement as public and private payers mainly study the imaging services. Radiology Medical Billing and coding is often considered unmanageable by most professionals because it is hard to stay updated on the single-payer changes and regulation changes. In restless environments, billing and coding disagreements are not uncommon.

There is always a chance of having compliance issues, plus there might be lost or under-coded charges. But, usually, the majority of errors can have when claims conflicts or audits perform. Therefore, both medical billing and coding services play a significant role in staying feasible.

Here are some latest changes that are affecting radiology services.

  • Coding Provisions and Revisions

National Correct Coding Initiative (NCCI) and The Centers for Medicare and Medicaid Services (CMS) have made revisions regarding coding and altered the coding policies. For example, NCCI has made code corrections for radiotherapy planning procedures, while the CMS has changed coding practices for low-dose CT lung cancer screenings.

  • The Boom in Data Analytics

The experts from the industry manage to point to data analytics that are driving the medical facilities currently. For example, big data and workflow analytics help drive more value, ensuring the process moves more efficiently and modernized.

  • Value-Based Payments

Many radiologists participate in the physician quality reporting system. Every year, the purposes under PQRS tend to increase. If one wants to get a bonus under this system, reporting successfully on three measures per physician is mandatory.

The American College of Radiology says that the numbers of radiologists who have successfully qualified for incentives under the PQRS have increased each year. Approximately 76.3% of radiologists paid approximately penalties that amounted to $2,654 in the year 2016.

  • Managing the Swift in IT systems

Radiology practices lead to change the IT systems that face several data migration difficulties. Therefore, they must work under the IT system businessperson to get a practical migration program and make possible plans. 

  • Improve the Workflow Management

The driving workflow in the healthcare sector is as several radiologists are working in larger groups.

Ideally, radiologists are under increased monitoring for billing errors and inconsistencies. An article reported that imaging utilization had increased many in the last decade without a corresponding increase in payment. Thus, it increases the gap between reimbursement and productivity.

Hence, outsourcing radiology billing services would help resolve many of the issues listed above and streamline their essential activities for the radiology practitioners. Furthermore, outsourcing the radiology medical billing services will ensure that all the diagnostic radiology coding and payer rules and procedures follow correctly. 

 

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Dennis L. Hernandez
I am a medical biller, a blogger and have 20 years of experience in medical billing, medical billing management, and medical assistant. My background includes positions as a clinical medical assistant, medical records technician, medical office manager, biller, and coder.

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