How to Avoid Radiology Claims Denials?

For successful radiology practices, error-free claim and timely submission is one of the key aspects that improve practice cash flow but also reduce the overall billing cost.  In radiology billing services, most of the medical claims are denied by the payers due to some reasons. Incorrect information of patient’s insurance coverage, eligibility is one of the main reasons for radiology claim denials. Let’s discuss the reason for radiology claim denials and how to avoid them.

Focus on Insurance Plan Information 

Having right insurance plan is an important element in medical billing.  Collect the below details to get the full reimbursement without any rejections.

• Name of the plan
• Subscriber Name
• Group number
• Coverage effective dates
• Secondary /supplemental coverage

Verify Basic Demographic Details of the Patient:

Ensure the patient fills all the details without any error at the time of registration.  Below is the checklist to be verified:

• Patient’s address
• Phone number
• Date of birth 
• Email address
• Patient’s current employer.

Medical Necessity

Medical Necessity is one of the reasons for radiology claim denials. Every insurance payer has developed their own payment policies. Due to the insurance carrier's payment policy, payment for some procedures (like chest X-rays exams) should not be paid for the providers. In such cases, they have to submit a complete record of patient’s medical history. By submitting the medical necessity document, we can avoid the claim denials.

Proper Authorization before Providing the Service

For MRI, CT and PET imaging services, prior authorization is required. If the imaging service provided without authorization, then it will lead to denial of claims.. For this reason, collect all information about the patient’s conditions and reason for the exam at the time of patient’s registration. 

Place of Services and Coding Documentation: Radiology practices should be aware of the place of service distinctions. When claims get submitted with incorrect place of service, claim would get denied. Also, accurate Coding documentation including Exam Name, Description, and Clinical Indication etc. is the key!

These are the common reasons for radiology claim denials.  To avoid radiology claim denials, most of the radiology practices outsource their radiology medical billing task to leading medical billing companies who take care of all their worries related to managing the revenue cycle.

About e-care

e-care is the top revenue cycle management company. Our company is an ISO and SSAE Type 2 certified medical billing company with over 20 years of experience in the healthcare industry. We provide quality medical billing and coding services for our clients. Our services help you to improve your revenue and provide quick reimbursement. To know more about our services, visit us https://www.ecareindia.com/