How to keep radiology claims denials at bay?

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How to keep Radiology Claims Denials at bay?

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In order to run a successful radiology practice,
it is important to ensure that claims for
services are submitted on time. This will not
only enhance the cash flow of the practice but
also keep the overall billing expenses at a
minimum.
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Common Reasons why Radiology Claims are
Denied The need for timely and error-free claims
submission is evident but at times, claims get
denied by payers due to various reasons, such as,
patient eligibility issues, failure in obtaining
authorisation for a radiology procedure or
insufficient documentation about the medical
necessity of an examination. When it comes to
patient eligibility, it is necessary that
the radiology practice is mentioning the correct
site of service or the correct information about
the insurance company (or plan) in the claim. If
the information doesnt correspond with the
payers records, claim will be denied and sent
back to the practice for correction. With ICD-10 
diagnosis coding, level of specificity needed in
pre-authorisation for imaging procedures has
increased to a great extent. If these services
are being performed by the radiology practice
without obtaining prior authorisation, it will
result in denials. Claims will also get denied if
there is a mismatch between authorisation and
exams performed. Similarly, if there is lack of
good documentation supporting the reason for
performing an examination, then also claims will
be denied because payers have strict protocols
dictating the conditions under which certain
procedures should be performed.
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Keeping Radiology Claims Denials at Bay There
are several factors that a radiology practice
needs to consider in order to reduce denials in
the first place. For instance, practises need to
identify the source of denials and ensure that
there are no data entry errors at the time of
registration. The practice should review its
medical coding process because coding error can
also result in delayed or denied payments. A good
authorisation management system should be
implemented and authorisation denials should be
regularly monitored and tracked to identify the
source of problem. It is necessary to take a
proactive approach towards medical necessity and
CDI (Clinical Documentation Improvement) as
well. Many radiology practices prefer to
outsource billing tasks to a third party because
it gives them the freedom to focus on patient
care. By letting a reputed medical billing
company handle their revenue related worries,
they manage claims denials proactively and get
paid on time.
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