Radiologists, who have been striving to maintain a balance between diagnostic priorities and operational compliance, may well find pulled further into a host of billing and compliance issues throughout 2013:
To begin with, they will have to discern the vital connect between diagnosis coding and procedural coding systems and the systems that have evolved to provide a common method of describing diseases, diagnoses, and procedures.
Second, like in other disciplines, they may be bound by the medical necessity clause while diagnosing high-cost tests. In fact, Medicare requires that the medical necessity of high-cost diagnostic radiology tests be proved and the extent to which they may be prescribed for beneficiaries by either primary care physicians or physician specialists. Therefore, radiologists need to be aware of both the medical necessity as well as the extent to which beneficiaries are entitled for radiology reimbursement under Medicare, Medicaid, or commercial health insurance plans.
Third, admissible radiologic expenses for Part B imaging services may be rationalized on par with industry standards. As a result, radiologists may see their reimbursements dropping or appreciation depending on where they stand vis-à-vis industry standards.
More importantly, radiologists may be under increased monitoring for billing errors, and irregularities. It could even lead to being black-listed for repeated history of billing malfunction. Therefore, it may require a concerted effort to stay clear of being guilty under Medicare, Medicaid, and other HHS programs or commercial health insurance plans.
These ensuing operational issues may prompt radiologists to:
Screen medical necessity and ask for advanced beneficiary notices (ABNs) on Medicare patients. This could require radiologists to function in tandem with the facility staff at the patient’s hospital to ensure the ABNs are accompanied by component fee as well.
Be prepared for Recovery Audit Contractors (RACs) and Comprehensive Error Rate Testing (CERTs), which are integral to standard scrutinizing. This would call for tactical and shrewd documentation and explanation of the radiologic services billed for claiming.
Evaluate templates and exam titles in accordance with the prevailing standard of equipment, technique or procedure, and the admissible CPT codes as amended from time to time.
Establish smooth communication with billing processes during revision to equipment, techniques or procedures. This would ensure that the modifications are adequately reflected in coding and billing, and claims are devoid of either under-coding or up-coding.
Make provision for reporting discrepancies, such as number of views or extent of technical complexity. This could help radiologists recover maximum claims as well as minimize the chance of denials and auditing issues
Even as radiologists seek to implement tactical moves to counter the impact of billing issues, they may find themselves swayed more towards clinical focus. That is why it makes sense to hire Radiology Billingspecialists for the purpose. Medicalbillersandcoders.com – having nation-wide affiliation with a chosen pool of radiology billing specialists – offers to deploy billing resources that are competent and experienced to address and maneuver radiologists through the billing issues likely to surface in 2013.
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