Are you sure about the accuracy of your radiology claims submitted by the in-house medical billing team?
Medical offices often work in a fast-paced healthcare environment where common, even simple, radiology billing mistakes can and do occur.
Unfortunately, even the minutest errors can lead to denials of the claims submitted, thereby delaying medical payments.
Depending on various statistic sources, NBC News report states that medical claims observed around 7% to 75% of error rate in the medical billing and coding. Regardless of the error rate, the AMA says that “medical coding errors fall under the broad categories of abuse and fraud.”
Apart from adding cost to your medical practices, these mistakes or errors can also hamper your relationship with the patients. Therefore, reduce your error rates and unnecessary costs, along with keeping your patients happy by avoiding the common radiology medical billing and coding errors.
Using an outdated codebook or entering the wrong code by your biller or coder will result in claim denials. If you’re using outdated coding books such as ICD-9 (International Classification of Diseases), CPT (Current Procedural Terminology), or HCPCS (Healthcare Common Procedure Coding System), or even superbills, your practice could face a significant loss in revenue. Moreover, inadequate documentation arises when a required supporting medical document is missing or when documentation is insufficient, supporting the payment for the billed radiology services.
While coding and submitting the claims, you have to ensure that what is documented must be billed. In the absence of such documentation, the carrier considers the radiology services as not performed. However, claim denials concerning insufficient documentation and improper coding are more complex as providers need to improve the process themselves, ignoring the patients’ time.
Many times, it is a human error when a duplicate bill arises. This usually occurs because of the re-submission of a claim and not removing it from the patient’s account. Thereby, all the claims processing systems have a criterion that evaluates every claim received for the occurrence of any potential duplication. The claims are generally placed in two categories- suspect or exact duplicate. In fact, some of the claims may appear to duplicate only due to their service nature. This demands the proper coding of the radiology services with the applicable condition modifiers or codes to identify the claims as a separately payable service rather than a duplicate.
Exact duplicate claims can be identified in the radiology medical billing from the same following information:
- HIC number
- Provider number
- Type of service
- Place of service
- From the date of service
- Through the date of service
- Procedure code
- Billed amount
Services not Covered/Coverage Terminated
As insurance information keeps on changing, verifying the eligibility whenever the services are provided is crucial. Before submitting the claims, you have to ensure that your provided radiology services are still covered in their insurance plan, your patient’s coverage has not been yet terminated, and their maximum benefits have not been exercised. To ensure this, you must be aware of the patient’s insurance plan and the radiology services you are offering. Moreover, if you follow the correct guidelines using the supporting documents, even the insurance plans with a cap can cover your radiology services.
Some of the examples of radiology services are ultra-sounds, x-rays, fluoroscopy, and alike. Be proactive, ask the insurance providers each time and verify the eligibility before beginning the procedures and radiology services demanding the precertification as per the terms of the patient’s plan. You also need to supply the required authorization while filing the claims.
Avoid Common Errors with Our Radiology Medical Billing Services
Are you looking for alternatives to avoid these common errors?
Outsourcing your medical billing services to one of the best radiology billing companies is the best solution to your problems. Info Hub uses a high-volume expert approach towards radiology medical billing services to help you to eradicate the common errors and mistakes. With decades of experience, we are the valuable resources to partner with that corrects the errors seamlessly and quickly. We also assist you with the dedicated processing of the claims and collecting the money – efficiently and promptly. Contact us immediately for radiology billing outsourcing services and get a solution to your billing and coding problems.