Radiology Medical Billing can be challenging. Changing reimbursement rates, infrastructure costs, and payer mix are just some of the challenges faced by radiology practices. The field involves advanced imaging techniques used to diagnose and treat patients. The field is constantly evolving with new technology, new treatments, and CPT codes. Keeping up with the latest changes in policy and regulation is critical for radiology practices.

Complexities Involved in Radiology Medical Billing

Radiology medical billing requires special skills to ensure accurate billing. While the scope of services provided by radiologists has expanded dramatically, it remains a specialized field. Today's radiologists must interpret a patient's images without assuming a preconceived notion. As the number of modalities for imaging procedures increases, so does the complexity of the imaging process. For this reason, quality imaging facilities are essential.

The need for highly qualified and experienced coders is also essential in radiology medical billing. Some practice owners choose to hire in-house billers and coders to handle billing for their departments. However, in-house staff may not be aware of all the rules and regulations governing E&M coding. In addition, they may be overwhelmed with other administrative tasks. Luckily, an expert medical billing company can help overcome these challenges. Their team includes certified radiology billers with extensive knowledge of the field.

Complete and Accurate Documentation

Complete and accurate documentation is an important part of radiology medical billing. This documenting process helps the payers to understand what the patient has undergone during the exam and ensures proper reimbursement. Accurate documentation also minimizes billing errors. Radiologists should understand and use ICD-10-CM Official Guidelines when documenting the diagnosis and the treatment.

It is essential to use proper coding and documentation to maximize revenue for your practice. To do this, use a medical billing service provider with proper processes and safeguards. These services will use proper medical coding and submit claims electronically to the appropriate insurance companies. With accurate documentation, you can expect to maximize your revenue from your radiology practice.

Using radiology CAC-compliant software can help you ensure complete and accurate documentation. These systems have built-in tools for radiology and are designed to deal with large volumes of complex claims. The system will also guide billers in making appropriate decisions when applying modifiers and codes.

Keep atop of Policy and Regulations Changes

If you are in the radiology medical billing business, it's critical to stay on top of the policy and regulatory changes. These changes affect all types of healthcare providers, so you should be aware of them. For example, NCCI and CPT codes are updated quarterly, and any change in these codes could affect how your billing is processed. Additionally, changes to the Office of Inspector General's Work Plan will affect your radiology medical billing, so you should always stay up to date.

Updates in Coding Guidelines

The American Medical Association's CPT-4 code manual is constantly updated with new codes and updated guidelines. These updates affect billing for radiology services. Below you will find a list of the updates in the coding guidelines for radiology services. New codes are highlighted in red.

Updates in coding guidelines for radiology are vital for revenue capture. Correct coding reduces denials and ensures a higher percentage of successful claims. It also means accurate charges for patient care. According to the editorial panel, certain code pairs are performed together 75% of the time, so they should be bundled.

Additionally, a new category I code will be added in the Radiology section of the CPT. This code will report radiation dose and potential iatrogenic effects.

Diagnostic radiology exams require correct coding. While this process may appear simple, it is often a difficult task. The documentation required to support a diagnosis code may be unavailable or unclear. Furthermore, the diagnosis code must be consistent. To properly code diagnostic radiology exams, two key documents should be reviewed. Using only one document to document a diagnostic code can lead to unnecessary coding compliance risks.

Keep a Tab on Deletion and Addition of CPT Codes

As the number of CPT codes continues to grow, you must know how to keep track of the changes that will affect your practice. AMA's CPT guidelines are the standard for electronic reporting of physician and health care professional services. The AMA's CPT Editorial Panel combines input from the health care community to update and maintain the code set. These updates ensure that the CPT code set is up-to-date and representative of the modern health care system.

The AMA has released the 2016 edition of the CPT codebook, which is more user friendly and contains improved rationales for CPT code changes. The updated CPT codebook also explains the ramifications of CPT code changes and what they mean across the entire code set.