Radiology practices are feeling the pinch of deep reduction in imaging revenue and decreased volume.
Based on an analysis from Yale’s academic multi-specialty radiology practice, they saw a 70% dip in outpatient imaging since the COVID-19 crisis, including a 50% drop for emergent/inpatient services. Practices may anticipate losing about half their normal revenues by the time the end of the COVID-19 crisis arrives. Today we will discuss 5 ways to save money in radiology billing and coding that could help recover some big portion of lost profits without impacting image quality!
The lack of prior authorization is sometimes due to a lack of experienced medical coding and billing personnel. When patients register for an appointment, front office staff should gather as much information about their condition and reasons for examination as possible. All aspects must be recorded; it’s evident that referring physicians’ offices have previously obtained insurance company authorizations!
The process for authorization must begin at the time of the patient’s registration for an appointment, where front office staff should gather as much information about their condition and reasons for the exam. All details are important-it can be seen that referring physicians’ offices will sometimes have obtained insurance company authorizations already!
When a physician’s office fails to obtain pre-authorization, there may be dire consequences. Injuries from wrong-site surgery or wrong patient surgeries are one example. There is also the risk of sanctions from carriers such as exclusion from coverage if it is determined that a service was performed without proper prior authorization. In some cases, sanctions may be imposed retroactively on services that have been paid by carriers in error due to improper authorization.
Non-Specific Diagnosis Codes
The Centers for Medicare and Medicaid Services (CMS) decided in July 2015 that claims would not be denied due to specificity during the first year of ICD-10-CM.
Many practices interpreted this as approval to ignore specific ICD 10 CM Codes and even today continue to report non-specific codes. These facilities are struggling with putting processes in place so they can be sure about getting more detail on diagnoses before submitting them correctly! Let’s use an example: “injury”. It is better if you code a type of injury or symptom instead rather than just using generic terms like ‘injury’ which have no clinical meaning behind it – think ‘contusion’, ‘sprain’ or ‘laceration’. Injuries are not the only reason for imaging; evaluations for medical purposes should include any indication of which phase of care the exam took place in initial treatment, subsequent healing, or sequelae from a previous injury.
Incomplete Documents for Full Ultrasound Procedures
According to the same Fathom study, 12.6 percent of completed examinations charged as such do not include adequate documentation for Ultrasound procedures.
The 76856 code set is only complete when all necessary evaluations and measurements have been completed.
To bill this procedure as an Ultrasound pelvic (non-obstetric), or real-time with image documentation; you must first evaluate the urinary bladder, prostate gland/semen storage facilities in males respectively. Furthermore, any potential pathologies on-site during diagnosis should also come under consideration for how much it will cost before claiming completion.”
When radiologists fail to properly document their procedures, it can result in a missed opportunity for reimbursement. The amount of money you are missing out on will depend upon whether your practice only billing global or also includes professional components like P&C insurance premiums (which may be separate).
This is a major issue that needs to be addressed by the medical community at large as it not only impacts revenue but also patient care. Radiologists must take extra care in documenting complete ultrasounds procedures for everyone involved to receive the appropriate benefits.
You May be Missing Out on Some Views
Missed views are an unfortunate reality of life. When referring to radiologists’ dictation, it is not always straightforward as they sometimes dictate multiple views which leads some coders to classify a study with just three images when there should actually be four presented on-screen- left oblique and right if available or lateral view, in addition, the average up top and posterior look down respectively.
MIPS Codes That are Not Captured
The payer and provider industries are struggling with capturing MIPS Codes. CMS estimates that performance could increase payments by 6%. This is a 15% swing in reimbursement, but practices continue to struggle because coding staff often do not have the time or training needed for these critical codes – even though there are clear guidelines available!
A lack of coders who can capture metrics effectively leaves many patients without fair compensation from their healthcare providers which ultimately impacts everyone involved downstream: consumers price out services they need due to higher cost; private insurers lose money on lower-quality care than necessary; Medicare and Medicaid spending balloons as does the national debt.
This is where radiologists can come in to help their practices capture missed revenue.
Radiologists should focus on dictating the correct number of views to ensure all codes are captured – it’s a simple way to make sure you’re getting paid fairly for your work.
It’s important to remember that when you dictate a study, include all relevant views even if they were seen on prior exams. This will help to ensure that all necessary codes are captured and improve practice reimbursement.
In addition, always be sure to read through the report thoroughly and look for any additional codes that may be applicable. Doing so will help improve practice revenue and ensure patients receive the best possible care.
As you can see, there are many things to consider when performing an ultrasound procedure. One of the most important aspects is ensuring that all necessary codes are captured for reimbursement purposes. It’s not always straightforward as radiologists may sometimes dictate multiple views which leads some coders to classify a study with just three images when there should actually be four presented on-screen- left oblique and right if available or lateral view in addition to the average up top and posterior look down respectively. Regardless, your practice must capture these additional metrics so they’re reimbursed fairly (and patients receive quality care).
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