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Radiology is often riddled with complications when billing out charges for various encounter types.
The ongoing changes in the healthcare environment have necessitated that a billing team have dedicated and prompt follow through on denials and no claim responses. The range of patient care issues provided by Radiology is wide and varied. Even though our focus is on medical billing and accounts receivable management, our broad experience across the entire Revenue Cycle Management process in Radiology is why we can give you an advantage compared to in-house billing.
Our team at Etransmedia has the knowledge and skills necessary to successfully work denials and provide our Radiology clients with valuable feedback to assist in managing and decreasing the most frequently seen denial types, while streamlining revenue and increasing your practice’s collection rates. Getting you paid fast!
What we know…
The healthcare industry has changed drastically in the last decade, and most especially in the last year. Not a small part of these changes was the implementation of ICD-10 which has provided an entirely new set of challenges; especially for radiologists.
Radiologists cover many areas of medical care including Radiation Oncology, Pain Management, and Interventional Radiology. It is not limited to just reading an X-ray. A number of new codes and guideline revisions will be implemented for 2017.
Proposed are changes to Flouroscopy, CAD and mammography, as well as Ultrasound screening for Abdominal Aortic Aneurysm. Interventional Radiology will see new codes bundling some of the services they do (e.g. Open and Percutaneous Transluminal Angioplasty PTA). Pain Management will see changes to Epidural injections.
Include the appropriate injection code when billing your diagnostic arthrography. For example, 27093
(Injection procedure for hip arthrography; without anesthesia) is billed in addition to 73525 (Radiologic examination, hip, arthrography, radiological supervision and interpretation). Modifier 26 is appended to 73525 if you are reporting only the physician’s services. The arthrogram must be diagnostic in nature to be reportable with these codes. Be sure documentation shows medical necessity and findings are documented.
Be sure to read the entire description of the CPT code you are using. You may miss laterality or inclusion of another area. Radiologic examination CPT codes 73501-03 and 73521-23 are the codes for unilateral and bilateral hip examinations respectively, but you need to read to the end of each of these codes to see that the pelvis is included when performed.
On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases.
Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.
First Pass Clean Claim Rate
Boost in Revenue*
Reduction in Cost*
We’re always on top of all the latest coding and billing updates for Radiology practices. Additionally, to make sure all claims are reimbursed on the first claim submission, our system is able to pre-edit claims prior to the initial submission for possible billing/coding errors. Our detailed end of month reports keep our clients up-to-date on what is happening in their practice so any issues can be addressed quickly. Having an experienced medical billing team, with visibility into performance, is vital to your practice’s financial health.
Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.
*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others
Service and Technology Packages
Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice
Silver RCM Service
This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.
Gold RCM Service
This package includes the core RCM services with added denials, A/R management services, and full service patient billing
Ancillary RCM Services & Technology
Available to enhance any package