Imaging billing involves submitting claims and receiving payments from payers for services provided by radiologists. Imaging service encompasses various imaging procedures, such as MRI, CT scans, PET scans, angiography, mammography, MRA, ultrasound, fluoroscopy, and interventional radiology. As you know there are a wide number of procedures involved in your imaging center, so there are more than thousands of codes that you need to use accurately.
Additionally, imaging billing includes two definitive components: technical and professional. You need to use technical components only when you leverage imaging tools and supplies for imaging testing. When it comes to interpreting written reports and examining radiographic images, you should use a professional component.
The truth is that imaging center billing is more complex than other medical practices. Without a proper understanding of the billing procedure, navigating through it can be a challenging affair for you. It is important to understand the critical steps involved in your imaging center billing process to ensure less claim denials and maximized reimbursements.
Below are the critical steps involved in the imaging center billing process:
1) Patient registration:
This step is all about collecting accurate and precise information about the patients. This information includes the patient’s name, date of birth, gender, social security number, contact information, home address, insurance information, emergency contact number, medical history, referral information, consent forms, payment information, and demographic information.
2) Insurance verification:
This step requires you to confirm the patient’s insurance coverage and all the benefits before you provide insurance coverage.
3) Pre-authorization:
You need to obtain the necessary pre-authorization or approval from the insurance company before providing certain imaging services to your patients. Imaging services that require often pre-authorization are MRI, CT scan, PET scan, etc.
4) Procedure coding:
You must use appropriate CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases) codes to define the procedures and diagnoses you have given your patient.
5) Charge capture:
It is the process of accurately recording and documenting all the procedures and diagnoses in your imaging center. This step accounts for all the billable services so that you can bill them to your patients or their insurance companies.
6) Claim submission:
Now, you need to submit the claim to the patient’s insurance company. Make sure you include all the necessary information and documentation.
7) Payment posting:
Once you receive the payment, post the payment to the patient’s account. Then, reconcile it with the billed amount.
8) Denial management:
In case of a claim denial, you need to investigate the actual reason behind the denial. A denial can be caused by multiple reasons. Once you find the error, correct it, and resubmit it.
9) Patient billing:
If there’s still payment pending from your patients after the reimbursements from the insurance company, send a detailed bill that should outline all the services provided and the exact amount owed.
10) Take follow up on unpaid claims:
Take follow-up on delinquent claims or patient bills to ensure timely payments. If you have questions from patients or insurance companies, address them immediately.
11) Audit analysis:
Regularly reviewing billing and payment reports enables you to identify current trends, discrepancies, and the scope of improvements.
As you might have understood imaging services billing is a comprehensive affair and managing it without professional help is a challenging affair, especially when your sole responsibility is to ensure clinical care. This is exactly why most imaging centers are outsourcing their billing to a professional third-party revenue cycle management company like Sunknowledge. Outsourcing your billing job to Sunknowledge allows you to save operational costs by up to 80% while giving a strong revenue boost to your overall practice revenue.
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