Radiology Medical Billing

Outsourced Medical Billing Radiology Services You Need

Customized and Comprehensive Radiology Medical Billing

Radiology practices face difficulties as a result of declining reimbursement rates, rising infrastructure expenditures, and changes in the payer mix. Therefore, ensuring you can optimize reimbursements and maintain profitability is more crucial than ever. Medical center radiology billing services can help!

Radiologists might find it challenging to manage the specific invoicing requirements for radiological services. It’s a service that uses imaging methods for disease treatment and diagnosis.

Due to its continuously evolving advanced technology and treatment procedures, radiology has several intricacies. The radiology codes in medical billing often get updated, increasing the need for ongoing attention.

Radiology has two billing components, as opposed to other medical specialties: the professional component and the technical component. Radiologists and imaging centers must bill for the usage of radiological equipment, dyes, and machines as technical items.
Furthermore, the radiologist must bill the service under the professional part while interpreting the diagnostic data.

Our team is made up of qualified billers and coders who are aware of the complexities of diagnostic, therapeutic, and interventional radiology billing. We consider the impact of failing to distinguish between the technical and professional aspects of medical billing for radiology on a practice's bottom line. Therefore, we offer imaging centers, academic medical centers, and other radiology practices the billing and coding services they need to improve their financial performance.

Reliable Radiology Billing Services You Can Count on!

Both the doctor's time and the usage of any supplies or equipment can be charged for under the radiological services.

The technical component (TC) is made up of things such as equipment, facility charges, supplies, pre- and post-injection services, personnel, and more. Furthermore, the radiological test is examined, conclusions are drawn, and a written report including the results is submitted as part of the professional component (PC). The technical and expert elements of a radiological service are denoted by modifiers. They are two-digit numbers that are used to provide extra information about a process. These can represent repeated or numerous operations, such as bilateral radiography. While this might sound complicated, radiology medical billing companies know how to handle this efficiently and effectively.

Furthermore, modifier 52 must be used when invoicing for the technical component, and modifier 26 must be used when billing for the professional component. To prevent claim denial in the latter scenario, a formal report from the doctor performing the services is necessary.

Other examples of modifiers used for medical radiology billing include:

-22 - unusual procedural service
-32 - mandated services
-51 - multiple procedures
-66 - surgical team
-76 - repeat procedure by the same physician
-77 - repeat procedure by another physician

The total amount owed for the technical and professional components is included in the global fee, which also calls for a formal written report. Our radiology revenue cycle management team makes sure that every procedure complies with the necessary regulations.


Payment for Technical Components

Insurance carriers may choose not to pay for the technical component (TC) of radiology services provided to skilled nursing facility (SNF) inpatients and hospital outpatients during a Part A covered stay. Both the supervisory/administrative services provided by the doctor and the provider services are paid for by the fiscal intermediary (FI)/AB MAC. The FIs/AB MAC payment to hospitals includes the TC of radiological services provided for inpatients, with the exception of Critical Access Hospitals (CAHs).

Radiography and associated diagnostic services are paid for by the hospital in accordance with the Outpatient Prospective Payment System (OPPS). The radiological services provided to inpatients at an SNF will be covered by the SNF Prospective Payment System (PPS). According to agreements signed with the radiology practice, billing for outpatient services provided in SNFs may be handled by the service provider or SNF.

Medicare ensures appropriate reimbursement in line with the Medicare Physician Fee Schedule when the SNF submits the billing.

Radiology Billing for the Professional Component

Irrespective of the setting or the physician's specialty, medical professionals can bill for the professional portion of radiological services they provide to a specific patient. Payment will be made in accordance with the fee schedule for doctor services.

However, insurance companies only pay the professional component for radiological services given to hospital patients if the following criteria are met:

- Services provided need to be direct, identifiable, and discrete therapeutic or diagnostic services given to one patient.
- Services need to meet the fee schedule conditions.

Optimizing Reimbursements from Radiology Claims