How to Avoid Radiology Claims Denials — Authorization

Denials delay payment. They also add rework. Cutting denials is one of the simplest ways to protect cash flow. Discover some of the most common reasons denials happen and learn what you can do to prevent them with Healthcare Administrative Partners today.

Why Do Radiology Claims Get Denied?

The three top reasons radiology claims are denied are:

1. Patient eligibility: Errors in patient information or the patient receiving services outside of their covered dates
2. Authorization: A lack of prior authorization when it is required for a specific service
3. Documentation: Missing or incomplete documentation, including diagnosis support and required claim denials.

What Is Proper Authorization?

Proper authorization —  also known as prior authorization, preauthorization, prior approval or precertification — is the process of getting insurance approval for a service before the service occurs. It is one of the best ways for practices to avoid denials and other billing issues after the fact. Many insurance plans, including Medicare Advantage, requires this authorization for many radiology services, such as advanced imaging and nuclear medicine studies. Because of this, practices should confirm when authorization is required and obtain it before the service.

Other Strategies to Avoid Claim Denials

Whether you pursue proper authorization or submit all information after the service, there are some strategies every practice can use to reduce instances of claim denials:

• Identify necessary information: Claims generally require information like CPT codes and accurate patient information. You may need to speak with insurance providers about what they need for claims approval.
• Obtain information up-front: Collect patient and service information as soon as possible so you can double-check your information and submit it within the authorization period.
• Update authorizations as needed: Changes in services, procedures and appointment dates can affect eligibility, so communicate with providers clearly to ensure continuing authorization.
• Monitor details:  Even a small error can lead to a denial, so make sure all documentation is complete and accurate before submission.
• Implement an action plan:   When you make authorization and claims submission part of your staff's workflow, they learn how to submit claims more consistently. Develop a clear pathway to claims submissions and ensure everyone is trained on how to use it.

Get Less Denials with Healthcare Administrative Partners

Since 1995, HAP has been in the business of helping your business thrive. Throughout our history, we have partnered with physician practices across the country and helped them evolve through comprehensive revenue cycle management (RCM) services. Trust our experts to handle your claims, and subscribe to our blog to stay updated on this evolving industry.

Linked Sources

1. https://info.hapusa.com/blog-0/how-to-avoid-radiology-claims-denials-eligibility-problems
2. http://www.hapusa.com/6-proactive-medical-billing-tips/
3. https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria
4. https://www.mayoclinic.org/billing-insurance/insurance/insurance-approvals 
5. https://info.hapusa.com/blog-0/what-radiology-practices-need-to-know-about-the-new-cms-updates-to-the-icd-10-guidelines
6. https://www.hapusa.com/services/medical-admin-consulting/ 
7. https://www.hapusa.com/contact-us/