Radiology Billing: How to Reduce Write-Offs and Denials

The coding and billing processes in radiology practices are often tedious as compared to the other specialities. Not only is there a high volume of examinations, but also the documentation requirements need to be very detailed and precise. A common observation is that the industry-standard denial rate for radiology practices is nearly up to 30% - this leads to the radiologists collecting just 79% of the revenue they've earned. 

There are statistics which highlight the importance of taking steps to reduce the number of denials and write-offs. Even if the radiology billing services are outsourced, there are measures you can include in your practices to improve the financial outcomes. 

ABNs are needed for a freestanding imaging centre. 

The advanced beneficiary notice warns you and protects you whenever there is a possibility of payment denial for a procedure on the grounds of medical necessity. You must get ABNs on all mammograms and on obstetrical ultrasounds unless medical necessity is clearly specified. If you outsource your medical billing services, co-ordinate with your billing company and try to implement a way to transmit a few copies of the ABNs. Stay aware of the trends among the other providers. Always remember that if the ABN is not signed, it becomes a write-off automatically. 

Stay updated with the current documentation requirements for all CPT codes. 

Ensure that your report templates are reviewed at least on an annual basis so that all the titles are up to date, and the correct technical description of the procedures are included. If any equipment or technique is changed, keep your templates updated with the same so as to reflect the changes. Notify the billing department or outsourced radiology billing services agency in case of any changes in the protocols. They can ensure that the document is correct. 

This prevents the requirement to go back and update the information on the report, in case of the occurrence of a denial. See to it that you seek proper feedback from the billing department on a monthly basis to ensure adequate documentation. 

Implement policies to identify and address the report discrepancies if any. 

The sheer volume of exams means that errors are going to occur for sure. But it is necessary to have a formal policy to handle them. Ensure that the staff handling the dictation and the radiology billing staff have a clear means of communication. Know the measures to be taken when a potential error occurs or a discrepancy is identified. Assign the task of following up on each discrepancy to someone on the team with ultimate responsibility. Finding the discrepancies on the front end before they reach the payer is anytime better and cost-effective as compared to handling a denied claim.

Never fail to check for pre-authorization requirements. 

Radiologists depend on the physician who refers to them and if they are hospital-based, they depend on the facility to get paid. This makes the radiologists “blind” providers. When a patient is presented for an exam, then a prior authorization is needed. If the provider or hospital that has referred has not obtained the same, then it means that the radiologist is working for free.

Find out which exams and medical procedures require prior authorization and train the registration staff to be alert in case of those procedures. Inform the patient that it is a must when it comes to making an appointment for the exam. Ask your billing staff or outsourced billing service provider to provide you with the regular reports on write-offs or denials due to the issues related to prior authorization and the concerned doctors who order them. If the providers are repeatedly failing to obtain the preauthorization, contact them and ask them to cooperate. 

It is essential to minimize denials and collect all the revenue you've earned. Contact the radiology billing experts in the market and choose the best one as per your requirements wisely.