Medical reimbursement is continually getting more complicated. From Insurance companies refusing to pay, to Medicare and the Affordable Healthcare Act. It’s getting harder for facilities to receive their reimbursement. This is affecting all areas of healthcare, especially radiology due to the high cost of exams. Now what can you do to keep your facility ahead?
Knowledge is power – Aunt Minnie
The best way to prevent continual claim denials is to get to the root of the cause and understand why? Here are the Top 3 reasons for Radiology Claim Denials
Clinical Decision Support (CDS) – Novarad
CDS was passed into law in 2014. CDS implementation deadline was set for January of this year. Is your facility fully implemented with all the CDS requirements? CDS helps facilities determine more effectively what imaging cases are clinically appropriate. Helping to mitigate what is necessary and hopefully not face as many claim denials.
Accurate Reporting – Diagnostic Imaging
Structured reporting is key to getting your full reimbursement. CPT code changes happen every year. If you implement structured report templates each year it can significantly increase the rate in which you are getting paid for those services performed.
Make sure they know you’re necessary – Health Imaging
Establish that the study is a medical necessity! Stating “no pre-auth required” is basically screaming “don’t pay me!” It’s also good customer/patient care to try to ensure that as much of their claim as possible will be covered by their insurance. There are resources for your facility to help ensure coverage, such as a medical-necessity checklist readily available from insurers etc.
Medical billing and reimbursement is something that is going to continue to change and evolve as insurers continue to crack down on coverage. Ensure that your facility does not become weighed down as a result of this. You want to be proactive so that your facility receives the financial compensation it deserves!
This post was written by Allie Robinson, a business policy analyst and content writer with Novarad.