How to manage radiology claim denials?

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How to manage radiology claim denials?
When the radiology physician submits the
error-free claim on time then the practices cash
flow will improve and the overall operational
cost gets minimized. However, you may find delays
in payment due to radiology claim denials from
the payer for some reasons.   When claims get
denied, the patient will be vulnerable first as
the entire burden of paying back falls on the
patients shoulders. In such situations patients
tends to call the practices billing office to
complain then the billing office need to handle
the phone call, research the problem, obtain
corrected information, and re-submit the claim
within the stipulated time. Now, let us discuss
how you can manage radiology claim
denials Patient eligibility problems Are you
deeply observing the patients eligibility before
submitting the claim for Radiology services?
Because the problems with patient eligibility can
lead to a chance of encountering radiology claim
denials. The problems with the patients
eligibility include the incorrect insurance
company (or plan) information on the claim or
listing the incorrect site of service.
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How to manage radiology claim denials?

• Various payers especially Medicare, expect all
  related information about the patient to
  correspond exactly with their records and a
  mismatch with the information will create a
  denial of the claim. This denied claim needs to
  rework by the radiology group to make the
  correction which adds extra effort.
• Apart from eligibility problems, providers should
  look for Prior authorization some services need
  PA for payments. Lets discuss the assessment of
  PA requirements in detail.
• Assess pre-authorization requirements
• The radiologist should obtain prior authorization
  before rendering the services as payments are
  denied for procedures performed without the
  required authorization.
• Radiology exams that may require
  pre-authorization include
• Bone Mineral Density exams ordered more
  frequently than every 23 months
• CT scans (all diagnostic examinations)
• MRI/MRA (all examinations)
• Nuclear cardiology

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How to manage radiology claim denials?

• PET scans
• Stress echocardiograms
• This PA should begin at the time of the patients
  registration for an appointment. In this process,
  the front office staff must gather as much
  information as possible about the patients
  condition and the reasons for the exam.
• The payer is looking for information that matches
  its records and payment criteria hence all
  details are important and sometimes radiology
  department or imaging center staff need to
  contact the referring physicians office. Once
  everything gets lined up then only the radiology
  group will be paid.
• Failure to document the medical necessity for the
  exam
• Under this category, the claim denials usually
  occur due to the information conveyed to the
  insurance payer and not from the physicians
  patient care decisions but when it comes to
  supporting the reason for the exam is crucial
  good documentation helps, including details from
  the patients history.

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How to manage radiology claim denials?
For Example  There are certain protocols from
payers for the condition under which certain
procedures are to be performed. The healthcare
provider should be sure that the exam performance
is medically necessary in the diagnosis or
treatment of the patients condition being
cautious not to order tests where the only
documented indication is to rule out a
particular condition. Use of technology for
radiology claim denials The use of technology
plays a big role in the revenue cycle
management process like Artificial intelligence
and machine learning helps in improving radiology
denial management and virtually removing
troublesome errors that cause a claim to
fail.   These technologies also enhanced the
automation that allows to capture data and have
an interaction with various insurance companies
to make the difficult tasks much easier and
lastly, AI can submit clean claims and decrease
denials with perfect denial management by
automating the front-end process.   Now you can
easily manage radiology claim denials, still, you
can outsource your radiology billing to a leading
medical billing company like us. We are one of
the best radiology billing company and we help
you to minimize the denial rate and maximize the
billing collections.