HAP Radiology Billing and Coding Blog

How to Choose a Radiology Revenue Cycle Management Vendor - Part 2

Our first article in this series provided a list of questions to ask when evaluating a professional services Revenue Cycle Management (RCM) vendor for your radiology practice.  If your current RCM vendor cannot answer all of them positively, it’s time to look for a new vendor.  With a large number of RCM companies available in the market, how should you decide which one to choose?

Categories: radiology reimbursement, radiology billing, radiology coding

How to Choose a Radiology Revenue Cycle Management Vendor – Part 1

When a major hospital-based radiology practice realized that their outpatient volume had dropped suddenly, their Revenue Cycle Management (RCM) company stepped up to quickly diagnose the problem. Using their analytic database, they produced a focused referring doctor report that revealed significant outpatient service volume declines concentrated among a handful of providers, one of which had decreased by 60%.  It’s this kind of responsiveness that sets a true RCM partner apart from the average vendor.

Categories: radiology billing, radiology coding

How to Document y-90 Radioembolization Cases to Maximize Reimbursement

Interventional Radiology Meets Radiation Oncology – The y-90 Story

When a physician is performing an interventional procedure valued in the range of $4,000 – $6,000 for the professional component, attention to thorough and accurate documentation is a requirement for maximal reimbursement.  Each case presents its own individual set of circumstances and a well-constructed operative report will tell the story of the case step-by-step.  Each artery or branch into which a catheter is placed for diagnostic imaging or intervention is assigned a separate CPT code, and so the operative report must describe with specificity each catheter placement.  When these descriptions are in a logical, sequential order, certified coders say that this allows them to better understand every aspect of the case so they can then accurately identify and apply up to 45 CPT codes to maximize reimbursement for it.  A descriptive evaluation of each artery supports payment of the codes that are submitted for reimbursement.

Categories: radiology reimbursement, radiology billing, physician reimbursement, radioembolization, interventional radiology, nuclear medicine, y-90

Is Your Radiology Practice Ready for the New HCPCS Modifiers?

Four new HCPCS modifiers will be available for use beginning in 2015, according to a recent announcement by the Centers for Medicare and Medicaid Services (CMS).  Known collectively as the –X{EPSU} Modifiers, they will be used to define specific subsets of the CPT Modifier -59 for a “Distinct Procedural Service”.  The new modifiers are intended to offer more precise coding options that will allow practices to avoid potential payment delays, audits and reviews associated with modifier -59.  CMS says that -59 is the most widely used modifier, covering a wide variety of circumstances such as to identify different encounters, different anatomic sites and distinct services.  Because modifier -59 is so broadly defined, it is often used incorrectly and inappropriately.

Categories: radiology billing, medicare, radiology coding, medicare reimbursement, modifier -59, mppr, X{EPSU} Modifiers, cms

Evaluating the Impact of the 2014 MPFS on Radiology Reimbursement

When the dust finally settled, we could see how the 2014 Medicare Physician Fee Schedule (MPFS) would impact radiology reimbursement, and results were mixed. Hospital-based services came out ahead while imaging centers generally took a big hit. Due to the many factors that contribute to the calculation of the final fee schedule, a weighted analysis will help you determine the actual impact on your practice.

Categories: radiology reimbursement, radiology billing, regulatory, medicare reimbursement

Radiology and Radiation Oncology: Regulatory Changes for 2014

The Medicare Physician Fee Schedule (MPFS) contains lower reimbursement in 2014 for diagnostic imaging and interventional radiology due to revisions adopted by the Centers for Medicare and Medicaid Services (CMS) in the annual Medicare rules update published in December. Radiation oncology practices will see a slight increase in the fee schedule while freestanding radiation therapy centers are facing considerable reductions. Meanwhile, Congress took some action to defer even larger cuts but continues to leave the medical community uncertain of future payment rates for physician services.

Categories: radiology reimbursement, radiology billing, medicare, radiation oncology reimbursement

CMS to Deny Imaging Claims without Proper Order Information

CMS, the Centers for Medicare and Medicaid Services, has announced that it will begin full enforcement of rules concerning physician orders that have been in place since 2009. These rules will impact radiology billing. Beginning January 6, 2014, claims submitted for imaging services will be denied if they do not accurately report the name and NPI number of the ordering/referring provider.

Categories: radiology reimbursement, radiology billing, regulatory, medicare

Radiology Billing Denials - Don't Take No for an Answer

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.

Categories: radiology reimbursement, radiology billing, denial management

Radiology Billing – Don’t Lose Legitimate Revenue to the MPPR

In recent years, the Centers for Medicare and Medicaid Services (CMS) has broadened its use of the Multiple Procedure Payment Reduction (MPPR) methodology to reduce Medicare payments to physicians, but there may be situations where your practice can justify avoiding this payment reduction.

Categories: radiology reimbursement, radiology billing, physician reimbursement, regulatory, medicare reimbursement

Monitoring Physician Reimbursement for Underpayments in Radiology

Imagine that your radiology practice realized a $750,000 in underpayments in two years. Now consider the impact such a shortfall would have on your practice’s ability to grow or even sustain itself. In this actual case, a payer was reimbursing 10 of the group’s physicians correctly while underpaying another 15 for the same procedures at the same time. This is a vivid lesson in the importance of continually monitoring third-party payments to ensure payers are reimbursing you at your contracted rates.

Categories: radiology reimbursement, radiology billing, physician reimbursement, contract management, physician underpayments

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