The foundation of accurate and reimbursable billing services is “correct documentation”, if there is a fault in the information that is mentioned in the documents then your radiology billing services would impact your revenue collection negatively. For diagnostic imaging centers, it is especially true that accurate reimbursement hinges on extremely accurate documentation and current coding guidelines.
And if you are not getting it right, you are leaving money on the table _ in the form of catastrophic claim denials and underpayments. Moreover, if you have kept in-house radiology billing services then incorrect documentation would increase your staff hours reworking claims for insufficient or incorrect documentation. So, radiology practitioners would also have to stay engaged with the medical billing cycle to bring accuracy and best results. Hence, they cannot find sufficient time to improve the patient experience.
In addition to this, mistakes in radiology billing services can hold up your reimbursement and damage your radiology business in the following ways;
1. Not documenting the actual number and specific views in a study:
Did you know? A simple knee examination process involves four different CPT codes based on the number and type of views. If the precise numbers and specific views are not mentioned in the documentation then you have to code to the lowest level. Just a simple list of standard views for each exam is insufficient to prepare accurate documentation.
Therefore, the imaging report must contain information about all of the procedures that were done, so that accurate medical codes are used for the medical bill creation. Mentioning all the four procedures in the medical bill is sufficient, however, it is even better if the radiology billing specialists can give details such as “AP, lateral, and both obliques” to support the validity of the CPT code. Therefore, make sure the key number of views is used instead of the number of films.
2. Omitting essential components in the imaging report:
The American College of Radiology has defined the following attributes that are required to prepare imaging reports;
- Exam Name.
- Clinical indication/reason for the exam.
- Description of exam, sequences, and/or technique.
- Comparison studies if applicable.
- Findings.
- Conclusion and recommendations, if indicated.
- Physician’s signature
There are also attributes associated with the medical codes that are needed to be mentioned in the medical bills including; laterality where applicable and details such as whether the study is a repeat of a prior study. If any piece of this information is skipped out then your radiology billing services would end up in claim denials or rejections which will reduce reimbursement rate.
3. Failing to distinguish and document scout films:
A supine abdomen or scout KUB is typically performed with an upper GI series and in order to support the correct code, the KUB and findings must be mentioned separately from the upper GI. in simple words, “Preliminary films were obtained” is inadequate to meet documentation requirements.
Similarly, an esophagram is typically bundled into the upper GI series. However, if in some cases, the radiologist can perform multiple views or a cine esophagram then medical billers should support medical necessity in the documentation for the separate esophgram. They can also use separate medical codes with a modifier -59.
4. Not documenting every aspect of a “complete” ultrasound exam:
There are strict criteria for what constitutes a complete abdominal ultrasound or renal ultrasound, and each organ or structure must be documented in the medical report to justify that “complete” code set is used in the medical claims.
If any anatomical structure is missing, then medical billing specialists should also use down-code to a limited study. It is essential for successful radiology billing services to have a permanent record in place and measurements for diagnostic ultrasound studies.
5. Incompletely or incorrectly documenting and coding contrast studies:
CT scans and MRIs are only considered contradicts studies if the contrast is administered intravenously; oral and rectal contrast doesn’t count as a contrast study. Beyond that, make sure the documentation accurately reflects whether the study was performed without IV contrast, with IV contrast or without accompanies by with contrast. It is essential for reimbursable radiology billing cycle to consistently supervise coding parenthetical to look for additional medical coding opportunities on contrast studies. Also mention document type and amounts of contrast for HCPPCS coding.
6. Not documenting nuclear medicine and PET supply kits:
Radio-pharmaceuticals are not considered in diagnostic nuclear medicine and PET scans and can be billed separately by hospitals and private imaging facilities. It is a true essence of the accurate radiology billing cycle to mention “Type and amount of radio-pharmaceuticals” in the technique portion of the study before adding the information about supply codes.
Conclusion:
The “golden rule” of reimbursable radiology billing services is to use accurate documentation. If a service is not accurately documented on the medical bills then it is not done. Therefore, medical billers should carefully use CPT codes for all the procedures that are involved in the medical bills. Would you like to learn about improving the bottom-line of your radiology business with Authentic radiology billing services? Then outsource revenue cycle to a reliable radiology billing company to enhance your reimbursement rates and meet your financial goals. Contact us! To schedule a free business consultation.