In order to run a successful radiology practice, it is important to ensure that claims for services are submitted on time. This will not only enhance the cash flow of the practice but also keep the overall billing expenses at a minimum.
Common Reasons why Radiology Claims are Denied
The need for timely and error-free claims submission is evident but at times, claims get denied by payers due to various reasons, such as, patient eligibility issues, failure in obtaining authorization for a radiology procedure or insufficient documentation about the medical necessity of an examination.
When it comes to patient eligibility, it is necessary that the radiology practice is mentioning the correct site of service or the correct information about the insurance company (or plan) in the claim. If the information doesn’t correspond with the payer’s records, claim will be denied and sent back to the practice for correction.
With ICD-10 diagnosis coding, level of specificity needed in pre-authorization for imaging procedures has increased to a great extent. If these services are being performed by the radiology practice without obtaining prior authorization, it will result in denials. Claims will also get denied if there is a mismatch between authorization and exams performed.
Similarly, if there is lack of good documentation supporting the reason for performing an examination, then also claims will be denied because payers have strict protocols dictating the conditions under which certain procedures should be performed.
Keeping Radiology Claims Denials at Bay
There are several factors that a radiology practice needs to consider in order to reduce denials in the first place. For instance, practices need to identify the source of denials and ensure that there are no data entry errors at the time of registration.
The practice should review its medical coding process because coding error can also result in delayed or denied payments. A good authorization management system should be implemented and authorization denials should be regularly monitored and tracked to identify the source of problem. It is necessary to take a proactive approach towards medical necessity and CDI (Clinical Documentation Improvement) as well.
Many radiology practices prefer to outsource billing tasks to a third party because it gives them the freedom to focus on patient care. By letting a reputed medical billing company handle their revenue related worries, they manage claims denials proactively and get paid on time.