Radiology is vital for early detection of several serious health conditions. It helps medical professionals detect bone fractures, infections, cardiovascular diseases, and cancer. It mainly provides visual insights into our body. Hence, almost all medical facilities have a radiology department.
However, radiology billing is a complex procedure. Understanding the service and assigning proper codes is important. Otherwise, the claim may get denied. Hence, many imaging centers employ radiology billing outsourcing companies. They ease the process with their expertise.
How Does Radiology Billing & coding Work?
1) Understanding radiology coding
To understand the billing procedure, it’s important to consider both professional and technical aspects. Professional support refers to the service provided by a radiologist. The technical component consists of the equipment required for the test and other related costs. While preparing the bill, it is essential to apply the standardized system of codes. ICD-10 (International Classification of Diseases, 10th Revision) and CPT (Current Procedural Terminology) are the most used coding systems for radiology billing.
The ICD-10 codes describe medical conditions and diagnoses. It mainly refers to the reason behind the imaging study. Precisely, ICD codes express the specific medical problem and symptom. CPT codes are mainly used to refer to the procedures and services performed by the imaging center. For example, CPT codes are applicable for Ultrasound, Mammography, Bone or Joint Studies, etc.
Also, in some cases, additional medical coding fills the gap in supplies and services that CPT codes don’t cover. In this scenario, billing authorities use HCPCS (Healthcare Common Procedure Coding System) codes. Using the appropriate codes is crucial to receive the insurance claim seamlessly. Also, it is important to understand the overall billing procedure. Here, we will provide a detailed overview of radiology billing.
2) Insurance Verification and Prior Authorization:
When a patient visits an imaging center for diagnosis, first the radiologist contacts the insurance company for prior authorization. It refers to the approval that insurance will cover the cost of radiology. Also, the radiologist must inform the patient regarding any out-of-pocket expenses.
3) Rendering Services and Billing:
Once the radiologist gets the prior authorization, they render the required services. In this step, the radiology center must document all services rendered to the patient. Also, they must apply the correct codes for seamless clearance. It is crucial, or else the claim may get denied.
4) Claim Submission:
After rendering the services, radiologists must submit the claim to insurance for quick payouts. Many healthcare service providers send the claim through a clearinghouse. They check if the codes and other details in the claim are appropriate. Once verified they send the claim to the insurance companies.
5) Payment Clearance:
After receiving a radiology claim, the insurance provider reviews it and decides if they can process the claim. They go through the patient’s insurance plan and clear the payment as per the benefits.
Often insurance providers don’t cover the entire radiology expenses. The patient may cover it through their secondary insurance, or they have to bear the rest of the amount as an out-of-pocket expense. In most cases, imaging centers outsource the job to a third-party radiology billing company for their expertise.
Why is radiology billing complex?
Radiology billing is complex due to intricate coding, frequent insurance changes, prior authorization requirements, high claim volumes and of course changing regulations. With the need to differentiate between technical and professional components, manage bundling rules, and comply with evolving payer regulations, errors can lead to denials and revenue loss. Outsourcing to an expert RCM provider however can help you with error-free billing, faster reimbursements, and compliance, allowing radiology providers to focus on patient care while maximizing revenue.
Final Thoughts:
Radiology is essential in healthcare for the early detection of many severe health conditions. It is a complex process and requires the utmost expertise. Hence, many imaging centers depend on third-party radiology billing solutions. They have the knowledge of coding and documentation to ensure the insurance provider clears the claim. Also, outsourcing billing services will save significant time and cost. So, radiologists can focus on providing healthcare.
