Billing operations for radiology tests and procedures are different from most other specialties. This is because radiology bills can have two different billing components. These components are professional and technical.

As both these components have different reimbursement guidelines and sets of codes & modifiers, billers must have sound knowledge of billing requirements for both professional and technical services.

According to industry reports, almost half of all radiology diagnostic tests like CT scans and MRIs are denied by payers. Reports also highlighted that Cigna doctors denied over 300,000 claims after spending an average of 1.2 seconds per claim. Although a small percentage of denied claims were overturned after being appealed, most of the denials are due to inefficient radiology billing practices.

And so, to help providers avoid billing mistakes on radiology claims, we will discuss all the important pre-billing stages relevant to the specialty.

List of Radiology Pre-billing Stages

The pre-billing stage is a part of medical billing operations and includes everything from patient registration to claim submission. This stage is very crucial in the radiology billing process because it helps set up claims with accurate information. And without efficiency in this billing stage, denials are bound to plague providers’ revenue cycle operations.

Here is a list of all the important pre-billing processes in radiology billing:

1) Patient registration

In most cases, patients and providers interact for the first time during registration and appointment scheduling. In this stage, all important patient details are collected before insurance verification steps can be initiated.

2) Insurance verification

This is the stage where admin staff check patients’ health plan guidelines and coverage benefits. This process helps providers to understand reimbursement rates, co-payments, deductibles, and claim submission guidelines. It also tells the provider whether payers’ approval is required before delivering medical services.

3) Authorization for radiology procedures and tests

Authorizations are not required for all radiology procedures or tests. But certain over-utilized diagnostic tests like X-rays, CT & MRI scans may require authorization depending on insurance guidelines. This step is vital because if claims are submitted for unauthorized claims it will result in non-coverage denial.

4) Charge capture & Claim submission

When radiology services are being delivered, staff should capture all the charges simultaneously. This process helps avoid revenue loss for providers. Once all the charges are translated into codes they must be submitted to payers with proper formatting and documents. The best way to complete charge capture and claim submission is by using online tools and portals. This will help reduce errors and shorten delays

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About 30% of all bills submitted by radiology providers have errors that result in denials. These errors can be of various types. Some can be easily avoided with audits, while others need comprehensive billing knowledge. And as smaller radiology practices have limited resources, they often struggle to implement corrective measures to minimize errors and maximize revenue. But professional radiology billing services solve this problem not just for small providers but also for large healthcare organizations.

Radiology billing companies and their experienced resources support the revenue cycle needs of providers. Billing support by these experts helps free up more time for radiologists and testing centers. They provide numerous other advantages including:

  • Accurate verification of insurance & eligibility benefits
  • Swift authorization with minimum delays
  • Error-free charge capture
  • Reduction of radiology billing errors
  • Low claim submission costs

To learn more about the best practices of our radiology billing services that have helped a California-based provider to reduce practice management costs by 70% and increase their first-pass rate to 97%, please contact Sunknowledge Services Inc., a HIPAA-compliant healthcare revenue cycle management organization serving US providers & payers since 2007.


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