Radiology reimbursements have been impacted by the shift to value-based care and new payment models. That’s why many practices and imaging centers are looking to experienced companies that outsource medical billing services to stay ahead of the curve.
In January 2015, the Department of Health and Human Services (HHS) put forward two goals which have a major impact on radiology:
- Alternative payment models will be used to make one half of all Medicare payment to physicians and hospitals medical homes and accountable care organizations) by 2018
- 85% of all fee-for-service payments will be linked to quality or value by 2016, with 90% by 2018
Value-based models have changed radiology reimbursement and radiologists are finding it difficult to manage their revenue cycle under these new payment structures. The major issues that this specialty faces are as follows:
- Difficulty in defining value: A report in Applied Radiology cites an expert as saying that “value is very nebulous” and that defining value precisely in radiology can be problematic. For instance, reporting radiation dose does not capture either the risk of radiation or the benefits of the diagnostic test. To provide evidence of value, radiologists need to consult with referring physicians in an assertive but constructive manner so that patients get the appropriate investigation, says the author.
- Determining the right imaging test: There are many different types of imaging exams with a variety of applications for each, and it may be difficult to determine which the right one is. imaging is often requested by different treating providers during an episode of care. When the Clinical Decision Support for Advanced Imaging mandate comes into effect in January 2017, physicians ordering advanced diagnostic imaging exams will have to consult and confirm the use of approved, evidence-based appropriate-use criteria to get reimbursed for claims for the exam. Electronic health records (EHRs) are a powerful tool that can be used to help ensure a patient is receiving the proper imaging exam.
- Inconsistencies in coding: This is the result of incomplete documentation and can occur due to missing charge capture, failure to update procedures, or to provide details of supplies. Concise and precise documentation of procedures is crucial. Clinical indications should be listed separately, exam titles should specify anatomical site, views, and usage of contrasts, and the right terms and phrases should be used. Such clarity is essential for medical billing service providers to fulfill their obligations and help radiologists avoid costs reduction, denials, compliance issues and inefficiencies.
Radiology medical billing and coding companies help these specialists survive and succeed in the changing landscape. Their invaluable support to help streamline the billing cycle includes:
- Services of experienced, certified coders who stay updated with the latest codes and guidelines with continuing education
- Regular audits and compliance programs to promote faster, cleaner and increased reimbursements and regular monitoring of charge capture
- Tracking of the source of denials and insurance verification services to avoid errors in eligibility
- Checking of payment schedule before the patient visit to reduces delays in payments
- Verifying details of ‘with and without contrast’ imaging with the physician before billing
When it comes to population health management, radiologists play a critical role in improving communication via appropriate imaging, efficient use of resources, quality reporting, and providing data analysis and integration. Outsourcing medical billing services allows radiology practices to focus on these critical activities while decreasing the risk of payment denial.