Delays in reimbursements and denials are nothing new in the imaging center sphere and as the days are passing by the complexities within the billing and coding practices are increasing.  

Over the last decade, compliance rules have changed, physician reimbursements have fallen, high-deductible plans became common, and the costs of employing staff to provide imaging center billing and coding services have risen.  

These factors together have reduced the operational margin of practices across the country. Furthermore, the transition to value-based care and new payment models have affected imaging center reimbursements.  

To eliminate gridlocks in revenue generation you need to implement a well-defined strategy within your practice. But before that you must understand the chaos of imaging center billing arena.  

A report has suggested that 60% of the providers have said that their staff is spending more time on administrative tasks now than they did five years ago.  

Of course, with the advent of technology the clinical and administrative protocols in diagnostic imaging have changed, and along with that providers are grappled with increased administrative burden.  

You can lose potential revenue if your staff pick up the bad habits in imaging center billing services; and in these changing times with increasing work pressure if your staff does so, that won’t be a surprise! 

Here are the major mistakes you should always avoid- 

Insurance payers often require prior authorization for advanced outpatient imaging services like CT scans, MRIs, MRAs, PET scans, nuclear medicine studies, and nuclear cardiology services. A recent report shows that 12% of claim denials are due to missing or incorrect pre-authorizations, and 90% of these denials are preventable. 

Strategy to Overcome: Ensure your team verifies prior authorization requirements before providing the service. Develop a checklist for every imaging procedure that requires authorization, including a review of the patient's medical history and supporting documents like medical necessity and accurate coding. Consider using automated tools to track authorization statuses, reducing human error. 

In 2015, the Centers for Medicare and Medicaid Services (CMS) announced that during the first year of ICD-10-CM implementation, they would not deny claims solely due to diagnosis code specificity. This leniency led some practices to overlook the importance of using specific ICD-10 codes, resulting in ongoing issues in imaging center billing. Many facilities still make the mistake of coding symptoms instead of precise clinical indications. 

Strategy to Overcome: Train your billing and coding teams to use specific ICD-10 codes that reflect the patient's condition accurately. Invest in regular audits to ensure that the codes used are precise and up to date. Consider providing ongoing education to staff about the importance of specificity in diagnosis coding to prevent errors. Review documentation thoroughly to make sure clinical indications are clearly outlined. 

Scout films, such as supine abdomen (KUB) images performed alongside other imaging tests (like an upper GI series), must be documented and coded separately. Simply stating “Preliminary documents obtained” isn’t enough to support the correct codes. Proper distinction and documentation of each imaging service are essential to avoid billing errors. 

Strategy to Overcome: Ensure your team clearly distinguishes between scout films and other imaging procedures in both the documentation and coding process. Implement standardized protocols for documenting and coding scout films, making it clear when a separate charge should be applied. Providing detailed guidance for your imaging staff about how to document these tests can prevent errors and ensure accurate billing. 

There’s often confusion between contrast studies like CT scans and MRIs with intravenous contrast and those involving oral or rectal contrast. This confusion can lead to inaccurate billing, especially if a test was performed without IV contrast, followed by the addition of contrast. Misunderstandings about these procedures are a common cause of billing mistakes and denials. 

Strategy to Overcome: Clearly document the type of contrast used (e.g., intravenous vs. oral or rectal) and ensure it is correctly reflected in the codes. Develop a clear protocol for your imaging team to document contrast administration accurately and train them to distinguish between the various types of contrast studies. Regular audits of coding and billing practices can help identify where mistakes occur and ensure accuracy in documentation. 

Outsourcing imaging center medical billing and coding can help ensure adherence to industry best practices, standards, and regulatory compliance. A revenue cycle management organization that specializes in imaging center billing can assist you in maximizing revenue by implementing processes to validate interpretation reports, ensure accurate coding, submit clean claims, and secure timely and appropriate reimbursement. 

The financial stability of radiology and imaging facilities is intimately tied to prompt medical billing and reimbursement. Thereby, hiring medical billing businesses would substantially assist healthcare practices in growing their revenue.