As the population ages, the duration of people living with disability and pushing the prevalence of chronic conditions among one-third of the older adults in the developed countries and US is no exception. As a result, there is a steep growth in the radiology arena.
Another key factor that is driving this growth is low-cost, advanced, cloud-based imaging services.
However, it has been identified that most of the providers are missing out on their potential revenue with a skewed radiology billing and coding practice.
Where the job market is expanding, radiologists like you are having a problem with filling up the positions for administrative tasks.
The Radiology Billing Paradox
Consistent staff shortage is a central issue in the healthcare industry, and radiology is one area where staff challenges are more prevalent with shortage in radiologists, radiographers and clinical oncologists.
A new workforce survey in 2023, from the Radiology Business Management Association has identified that 69% of the radiologists were struggling with immense staff shortage in administrative aspects.
As a result, while you provide the services with utmost quality, you might be facing challenges in maintaining a streamlined revenue cycle.
But wait!
Staff shortage is not the only culprit here! The frequently changing payers’ claim submission guidelines, evolving coding system, transforming regulations and emerging technology make it difficult for the providers to keep up with the billing practices.
Coding errors are the most prevalent issue in radiology billing services. Truncated codes, missed modifiers, inconsistency in diagnosis and procedure codes are some of the major coding mistakes that your practice is prone to.
Missing out on insurance eligibility verification and obtaining prior authorization disrupt the radiology billing and revenue generation process.
In fact, studies have suggested that 12% of the denials are there due to inefficient prior authorization process and 90% of the authorization denials are preventable.
On top of that, radiology billing services demand a well-defined documentation of the process, and the documentation requirements are changing and increasing with every passing day.
It is not always easy to capture the correct number of views by referring to a radiologist’s dictation leading to underbill for services. For instance, consider a knee exam where the radiologist dictated ante posterior, lateral and oblique view of knees, many coders (read inexperienced!) will code a three-view study.
However, given that there will both left and right oblique view which makes is a four-view study.
Possible Solutions to Enhance Radiology Billing Services
To address the inefficiencies in your billing and coding processes, you can consider the following strategies-
Focus on accurate and comprehensive patient information collection and documentation, which elaborates the patient’s condition, medical necessity of the procedures performed and so on.
Always review the codes and other information before submitting the claims and stay updated with the coding and billing guidelines. While there are different payers operating in your area, understanding their claim submission requirements and submitting claim within their timeline is essential to obtain accurate and timely revenue.
Identify the gaps within your billing and coding process through periodic internal audits and learn about the staff training and education.
You can also opt for an advanced billing software system that can reduce the errors within your administrative processes.
Also, you can consider hiring outsourced expert medical coders and billers who have clear understanding and specialized skills to resolve the billing issues.
How Outsourcing Radiology Billing Services Can Help You
You might think outsourcing your radiology services will be more costly, and handing over the financial aspects of your practice to a third-party organization is a tough decision.
There are several benefits of partnering with a reliable revenue cycle management company that you can’t ignore-
- Expertise and experience
- Reduced overhead costs
- Increased time to focus on patient care
- Faster reimbursements
- Guaranteed compliance
- Highly integrated electronic health record system
- Industry-best practices and technology
- Reduced denials
- Increased cash flow
To Conclude,
Though radiology billing and coding processes present unique set of challenges when it comes to revenue generation, but with a strategic approach you can overcome that. Along with quality care, quality billing is also a major aspect of your practice to sustain the financial and functional stability of your practice. Whether you manage your administrative tasks in-house or outsource the services according to practice requirements, prioritizing accuracy, adherence to compliance and collaboration among the stakeholders is necessary to sustain a smooth workflow in your practice.
