Strategies to Maximize Radiology Practice Reimbursement

Radiology billing and coding are often seen as unmanageable. It’s difficult to stay up-to-date on the individual payer and regulation changes. Billing and coding inconsistencies may lead to claims denials. Here’s a closer look at some strategies to maximize radiology practice reimbursement.

  • Use of proper modifiers
  • Leverage Payer Contracts
  • Better manage denials

Use Proper Modifiers

Incorrect modifiers are one of the reasons for lost reimbursement in radiology practices. While submitting the claim, physicians have to mention where the radiology service rendered, who owns the equipment as a modifier. 26, TC, 76, 77, 50, LT, RT are few of modifiers used in radiology medical billing.

  • 26 – Professional component- This modifier is used when the physicians supervise and interpret a diagnostic test and write reports.
  • TC – Technical component – This modifier covers the cost of staff, types of equipment and non-professional components.
  • 76 modifiers used when the service rendered again on the same date of service by the same physician.
  • 77 modifiers used when the service rendered again on the same date of service by the different physicians.
  • LT / RT modifiers used when one side of the body was imaged.

Leverage Payer Contracts

Imaging utilization is managed by private payers using RBM (Radiology benefits manager). It requires pre-authorization processes. RBMs help get more tests approved and avoid unapproved tests that may go unreimbursed or become self-pay tests that can be progressively hard to collect payment for providing.

As payer contracting increasingly needs radiology groups to work with RBMs, skill on payer trends, appropriate coding and what tests are not considered as medically necessary will be essential for ensuring facilities are accurately reimbursed for their services.

Better manage denials

Insurance claim denials are one of the major obstacles affecting healthcare reimbursements. For better claims denial management, first, find out and analyze the denials & reasons for the denial. Claims are resubmitted with corrections to the payer. Enhancing claim denials management strategies maximize reimbursements and healthcare revenue.

Outsourcing

To maximize the radiology practice reimbursement, medical billing outsourcing is the best choice for a radiology practice. Medical billing experts always stay up to date with regulation changes and are efficient with the coding and billing proficiency required for radiology billing. About e-care

e-care is the leading medical billing outsourcing company in India. We provide various medical billing services such as radiology medical billing services, cardiology billing services, anesthesia billing services, revenue cycle management services. To know more about the medical billing and coding services, log on to our website: http://www.ecareindia.com

Source by Dean Smith

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