HAP Radiology Billing and Coding Blog

In our previous articles on avoiding radiology claim denials, we covered the top two reasons payers deny radiology claims — patient eligibility problems and lack of proper authorization. The third most common reason for medical insurance claim denials is failure to document the exam's medical necessity. Let’s take a look at this issue in detail so that your radiology practice can avoid such claims denials.

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Categories: radiology reimbursement, radiology documentation, denial management

How to Avoid Radiology Claims Denials — Authorization

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Categories: radiology reimbursement, denial management, claims denials

Claims for reimbursement of radiology services are most often denied by the payer, whether it is Medicare or a commercial insurance company, because they contain inaccurate information about the patient’s eligibility for coverage. This can occur for many reasons, some of which may not be within the control of the radiology practice, but it usually can be corrected by improving the process of recording data at the time of patient registration. In this new healthcare economy where radiology practices are under pressure to add value to the patient care delivery system, effective management of claims denials can strengthen the relationship between the practice or imaging center and the hospitals they serve.

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Categories: radiology reimbursement, denial management, claims denials

The goal of a well-managed radiology billing operation is to submit claims for services promptly and receive reimbursement as quickly as possible. Timely submission and prompt payment enhance the practice’s cash flow and keep the overall cost of billing at a minimum. All too often, however, payment is delayed because the payer denies the claim for some reason.

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Categories: radiology reimbursement, radiology documentation, denial management, radiology charge capture

Unfortunately denials are a fact of life, but in radiology billing, there isn’t much room for error. Due to the high volume nature of the work, errors can proliferate quickly. Denials not only represent lost revenue; the cost of resubmission or appeals can sometimes exceed the reimbursement value. Managing denials is an imperative, but without a smart strategy, they could be eroding your profitability.

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Categories: radiology reimbursement, radiology billing, denial management