Radiology billing has become increasingly more challenging, and success hinges on a proven process guided by industry experts that understand the day-to-day revenue cycle intricacies and nuances. The most successful radiology practices recognize they need a billing solution that can adapt to individual payor challenges and new regulations, has the ability to scale as growth opportunities present themselves, and is willing to invest in leading technologies with the overall goal in mind of improving revenue cycle management performance.
Some practices choose to hire their own billing staff. This requires a significant investment in people, office space, and technology that can substantially increase operating expenses, impacting overall practice profitability. Additionally, there is the challenge that comes with managing employee recruitment and retention, creating more risk and liability for the Radiologists and their practices.
For these and other reasons, many Radiology practices that bill in-house are looking more closely at third-party alternatives.
Other Radiology practices prefer to work with third-party billing companies that provide full-service revenue cycle management. These companies vary significantly in terms of size, location(s), sophistication, ownership structure, specialization, and technologies being utilized. But for various reasons, these partnerships don’t always work out. There could be communications issues between the billing company and the practice, an excessive amount of denied claims, or a lack of support in the area of coding and documentation, to name a few. After time, if these types of issues persist, a Radiology practice may decide it is time to switch billing companies.
The benefits of transitioning your practice to a Radiology-specific billing company are significant; selecting the right billing company to meet the needs of your practice, however, is not always straightforward.
The following information and insight can help you make an informed decision about your next billing solution ‒ whether you are considering using a third-party company for the first time or considering a change in third-party billing companies.
Why Is Accurate, Compliant Radiology Coding Important?
The primary job of a Radiologist is to analyze images and create a conclusion based on his or her findings. These findings are included in a comprehensive radiology report, which coders will use in the billing process.
The comprehensive radiology reports, including detailed documentation that Radiologists generate, are based on guidelines provided by industry-specific governing bodies, such as The American College of Radiology (ACR).
Radiology coders are then required to accurately assign codes based on the documentation provided by the Radiologists and regulatory requirements for public (CMS) and private (insurance and individual) payors.
All coders must remain educated on all of the latest CPT and ICD-10 coding requirements, CMS fee changes, technologies, and guideline revisions to support timely reimbursements.
Given the importance of accurate and compliant coding within the billing process, it’s not surprising that Radiology practices make this a focal point when deciding on their billing company solution.
What To Consider During The Selection Process
If your practice has decided that a billing company change is necessary, how do you go about the selection process? Research will lead you to numerous billing company options, many of which provide services for more than one specialty. Your practice’s search criteria should be unique to your practice’s needs, so it is essential to assess and document your requirements before getting too far into the vetting process.
Keep in mind your practice’s needs may have changed or grown more complex since you last evaluated billing companies, requiring a company now with more comprehensive offerings and services. Once you have defined your requirements and feel that you can begin to take a closer look at third-party alternatives, the following tips and information could help you identify the top billing companies for your practice.
If you are currently using a third-party billing company that is underperforming, it could be helpful to conduct a retrospective: identify aspects of your previous search that could be improved upon to ensure you find the right billing company for your practice.
Finally, there can be substantial financial and operational benefits in working with a third-party billing company specializing in Radiology. Be sure to ask the companies you are considering about their background and expertise in Radiology.
Why Choose a Billing Company that Specializes in Radiology?
There are countless aspects unique to Radiology billing that can have a profound impact on your selection process, including:
For these reasons, your practice should strongly consider selecting a billing company that specializes exclusively in Radiology. Radiology-exclusive billing companies can have a national or regional presence; the distinctions include the number of states the company renders services in, the total number of clients, the average size of the clients, and the guidelines specific to your state.
How to Assess a Provider’s Rates, Services, and Features
Services
Services and features can vary significantly from billing company to billing company. It is essential to understand what is included in the rate and what you may have to pay extra for. Further, not all services and features are created equal. Does the billing company provide you with your own dedicated account team accessible by phone when you need them, or are you simply getting a complicated automated phone tree? Be sure to focus on how companies you are considering define their offerings.
How Do Rates Relate to Services and Features?
Most billing companies charge their clients on a percentage of net collections. Different companies may use different calculations, so make sure there is consistency. It is also essential to know what billing and practice management services are included in the rates. Some companies may not offer value-added services, like payor credentialing and ongoing coding education, reflecting their lower rates. It’s critical to choose a billing company that provides services that fit your needs.
Communications
The billing company you select should be an extension of your practice. It is essential to ask questions specific to who will be managing the account and access you will have to that person or persons. Also, who will your patients be interacting with when they have a question about a bill or statement?
We also recommend that you ask to speak with client references of any prospective billing company to understand their capabilities fully and if they have met or exceeded expectations. Who better than a colleague who knows your field and what expertise, services, technology, and account communications are needed for an optimal billing services partnership?
Resist, if possible, any offers by the billing company to join in on the reference conversation; make it a one-on-one conversation with the references to get full transparency to aid you in your selection process.
Technology
A billing company’s technology needs to be secure and fully compliant at all times. Additionally, having access to a web-based Business Intelligence (BI) Tool is vital, so you do not have to rely on your billing company to provide you with updates on the practice’s financial performance. Regardless of which technology a company uses, your practice should have complete transparency into ongoing performance.
During your vetting process, make it a priority to discuss technology and ask questions about the availability of any Business Intelligence Tools. Additionally, understand what safeguards the company has regarding cyber security to ensure your patients’ and practice’s data are kept safe.
Process
There are countless steps involved in the Radiology billing process, and every Radiology practice has unique requirements based on contracts, referring physicians, and hospital arrangements. Any problem that arises throughout the process can negatively impact your collections.
When vetting billing companies, be sure to ask about the steps they take in critical areas, such as charge reconciliation, payment per contracted rates, denial management, and cash reconciliation.
How to Know You Are Choosing the Right Radiology Billing Partner
If you have assessed and documented your requirements and reviewed companies based on their specialization, services, rates, technology, and other relevant criteria, you should have a shortlist of billing companies to choose from that could help you manage and grow your practice. So what additional factors can help your practice make an informed, successful final decision?
