For radiologists, the process of billing and coding is often viewed as cumbersome. It can be, at best, difficult to remain up to-date on all the regulations and individual payer changes — let alone understand them. Yet it’s imperative for the practice to thrive.
Even when radiologists’ outsource their billing responsibilities, it’s still important for them to be aware of what they can do to aid in the processes and improve — or secure in today’s world of auditing — financial outcomes.
Here are five tips to help radiologists keep their billing and coding processes on track, so they can receive the payment they are entitled to and concentrate on their passion—radiology.
1. Monitor medical necessity and ask for advanced beneficiary notices (ABNs) on Medicare patients. When a service is not covered by Medicare due to lack of medical necessity an ABN should be provided to the patient. The ABN can cover the facility technical component and the professional component fee. The professional component ABN is frequently missed due to the assistance needed from the facility staff as well as the transmittal of the ABN (which is often in hardcopy) back to the billing company.
A radiologist should work with the facility staff at the patient’s hospital to ensure the ABN also lists the professional component fee. Additionally, the radiologist should request their billing company monitor trends from ordering physicians. These physicians need to be aware of the Medicare covered conditions prior to writing an order for a specific service. Radiologists should also coordinate with the billing company so they can receive a copy of the signed ABN from the patient. This coordination may seem clunky at first, but once a process is put in place, radiologists will experience fewer patient write-offs.
2. Keep up to date on required dictation needs. With audits such as Recovery Audit Contractors (RACs) and Comprehensive Error Rate Testing (CERTs) becoming a part of standard processes, radiologists need to be aware of the verbiage needed to describe the exams performed. Knowing the correct verbiage will help to eliminate costly appeals or having to provide additional information long after the original date of service. For instance, if a physician is dictating a CTA, they should be including documentation of 3D imaging.
If a radiologist is not receiving communication on CPT updates or feedback on documentation and where opportunities exist from their billing company, they should definitely ask. Resources to aid in identifying documentation requirements include the current version of AMA CPT, CPT Assistant and Clinical Examples in Radiology.
3. Review templates and exam titles. Because of the high volume of exams, most radiologists create templates to ensure all applicable documentation is addressed. These templates should be checked at a minimum annually with the CPT updates to make sure they’re still current. If the group changes equipment, a technique, or protocol, we recommend auditing the templates when this change occurs.
For instance, if the radiologist had been using analog equipment and now uses digital mammography equipment, the template should be updated to reflect that change.
4. Communicate with your billing company. When a change in equipment, techniques or protocols occurs, radiology groups need to notify their billing company. When the techniques or equipment have been changed, the radiologists should be reviewing and updating the templates as discussed in the previous tip. The billing company, being aware of the change, should act as a safety check for the group. Ultimately, the radiology group is responsible for the template updates, but the billing company can double check for accuracy and timely updates.
5. Create a process for report discrepancies. Occasional discrepancies in documentation, such as number of views, are inevitable. A group will see accurate payment for the services performed, and fewer denials and auditing issues, if they have a billing company that is willing to communicate the information that can be improved upon.
For example, we provide clients with quarterly dictation opportunities focusing on areas where trends have been established, whether it occurs at a specific facility, physician or exam level. We’ve found this to be an efficient way to work through discrepancies with the radiologists we work with.
Cherie Puthoff is director of coding for HealthPro Medical Billing and is a certified health information administrator, a certified professional coder and certified radiology coder. She is responsible for all coding, peer review and education of physician dictation best practices.