Unlike other medical specialties, radiology groups rely upon maximized revenue from higher volumes of daily procedures at generally lower per-patient costs. This means maintaining a steady flow of insurance reimbursements–Medicare or third-party payors–with minimal delays or denials. Yet most radiology practices remain plagued by the same persistent revenue problems–mostly resulting from little more than human error in the front office.
What are the most common pitfalls preventing radiology practices from filing a quickly reimbursed “clean claim”?
Registration Errors. Nagging insurance issues often start at the reception counter–when staff fail to nail down exact demographics from the patient. Does the patient’s name in their EHR match the name printed on their insurance card–does a male patient go by William or Bill, or has a female changed her maiden name after a recent marriage? Are their current address, telephone number and date-of-birth correct? When they say “I have Medicare”, is it original Medicare or a Medicare HMO?
Outdated Coverage. Claims are frequently denied when the patient’s previous insurance coverage isn’t updated. Have they recently changed jobs, or has their current employer shifted coverage to a different policy group? Medicaid-covered patients most frequently shift coverage, as their income levels change.
No Preauthorization. Radiologists are essentially “blind” providers–most often dependent on patient data forwarded from a referring physician. Most often, the patient requires a same-day appointment for diagnosis of an urgent condition–and office staff are rushed to secure a preauthorization after waiting in a lengthy phone queue. But when those emergency exams are later denied–barring a cumbersome appeals process–the practice is simply left on the hook for uncompensated work.
Incorrect Coding. Efficient, error-free medical coding has never been a strength of most radiology practices–even before the exponential expansion of diagnosis and procedure codes in ICD-10. While Medicare is cracking down on sloppy coding (as we’ve discussed), private payors are rapidly following suit. What may be a code for an urgent exam may be different from that of a lower-priority condition.
Where Does Your Practice Need Help?
With the entire healthcare sector adjusting to a post-ACA world, now is the time to do some self-evaluation of your radiology practice’s front office. What does your administrative staff do well, and where do they need an added “boost” to achieve the incoming revenue your practice demands?
Infinx has developed revenue management solutions specifically around the unique needs of radiology groups–to streamline your claims process to deliver maximum revenue:
- Our expert team of over 300 medical coders reviews each patient claim for coding accuracy before it’s submitted to the payor–double-checked by our in-house auditors.
- We confirm emergency STAT preauthorizations in a little as 20 minutes.
- Our account receivable specialists review your current and past A/R to optimize operations, ensuring a solid, steady cash flow.
How can Infinx deliver the perfect solution for your practice’s revenue problems–and give you a competitive edge in the fast-paced world of radiology? Contact us to find out more.