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Radiology Management Blog

How to Avoid Radiology Denials

Mar
29

avoid radiology claim denial

People who work in radiology practices all have one thing in common, which is the dread of these two words: Radiology Denials. Denials can significantly hurt practice cash flow and cause additional—and frustrating—work for office staff.

Fortunately, AuntMinnie.com recently created a series of posts about how to help avoid claim denials, and here are summaries and links to them.

Common Reasons for Claim Denials

The top three reasons are listed in the initial post. The first focuses on issues associated with patient eligibility, which could involve listing the incorrect insurance information on claim paperwork, or the wrong service site, as just two examples. The second reason is a failure to get proper pre-authorization for imaging tests: ICD-10 diagnosis coding requires more specific information to be provided, as just one example, and a failure to comply will almost certainly lead to a denial. Finally, insufficient documentation about medical necessity can also be problematic.

Avoiding Claim Denials

Part two of the series provides additional tips on avoiding radiology denials. The writer first points out that, although some patient ineligibility issues are beyond the control of the radiology practice, many can be corrected by the enhanced documentation of information at the time of registration. So, it’s worth the few additional seconds it can take to ensure proper recording of the insurance plan name, subscriber number, group number and coverage dates, as well as any supplemental insurance information. Be especially careful with Medicaid registrations, as coverage can change more frequently and effective dates can be retroactive.

Also be careful to double-check a patient’s address, phone number and email address, along with date of birth and current employer. If the employer has changed, make sure that the insurance coverage hasn’t also changed. Check photo IDs, because insurance theft is a growing concern.

Pre-Authorization Procedures

Yet another AuntMinnie.com post focuses on efficiently getting payor authorization for procedures, especially important for higher-cost ones such as CT, MRI and PET imaging. Fortunately, first steps are the same—obtaining correct insurance information from the patient.

It’s also important for your practice staff to stay up to date about how each insurance company handles pre-authorizations; some are managed in-house, while others outsource to third-party firms. It may make sense for the practice to schedule calls with insurance companies to get the most current processes and to ask each one for tips on how to make all work as smoothly as possible. Also ask the insurance companies to notify your practice when any authorization procedures change. When your practice gets radiology denials, analyze why and watch for patterns.

Don’t Forget about Medical Necessity

Yet another post focuses on medical necessity issues and how they relate to radiology denials. Again, knowing the specific policies of each insurance company is crucial to help prevent claim denials. These types of denials typically happen because there isn’t enough documentation sent to the payor; this is more common when the test has negative results. When creating documentation, provide information about why a certain condition was being explored, and then watch for denial patterns to proactively avoid them going forward. If you notice, for example, that a particular condition and/or image type is being more closely scrutinized by a particular insurance company, send more detailed information about them in the future.

Radiology Denials Got You Down?

Turnkey billing services by Vidius Solutions can take the challenges off your hands to help you free up time, accelerate cash flow, and reduce costs. You can focus on patient care, while we handle billing, coding, and collecting. We are experienced in capturing every charge so that every bill can be paid in full. Discover more about our revenue cycle management services and then contact us for your radiology solutions online or by calling 800-518-8230.

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