Three Tips to Minimizing Radiology Claim Denials

radiology claim denials

Although claim denials are an inevitable reality in radiology (and in every specialty), there are steps you can take to minimize dreaded claim denials that eat up time, money, and energy. By having comprehensive and all-inclusive processes in place for claims submissions and adhering to the process, you have a system set to ensure that the documentation submitted meets all requirements. Doing so optimizes cash flow and minimizes billing costs. 

So, put these three practices into play today!

Be Proactive: Having a process in place to secure prior authorizations (when required) is essential to ensuring that claims are promptly paid and don’t get stuck in the denial pile. Since imaging procedures like MRIs, CTs, and PET imaging come with higher price tags, taking a proactive approach to getting prior authorizations is critical. What’s more, ICD-10 diagnosis coding requires a high level of specificity when securing prior authorizations, so it’s wise to have a thorough process in place to make sure that prior authorizations are promptly handled – and handled correctly. You also want to make certain that the procedure performed is the same procedure noted in the paperwork. When it comes to prior authorizations, it pays to be proactive. 

Is it a Match? A second tip to minimizing radiology claim denials is making sure the information submitted is accurate, complete, and up to date is essential to determine patient eligibility. Securing accurate data is a critical part of ensuring a smooth process. Something as simple as being off a single digit in an address can result in denials. Getting all the details and information – such as service location, insurance company, group number, subscriber number, coverage effective date, along with the patient’s address, phone number and birthdate – is crucial. This may sound obvious, however, it’s the root cause of many denials. Every bit of information that is noted must match what’s already on record. Failure to do so is likely to trigger a denial – and then the information must be promptly updated and corrected. Best to have a process in place to get it right the first time around!

Necessary Measures: Prior to scheduling procedures, make sure that you have shown the procedure to be a medical necessary. Unfortunately, there are often other factors outside of the physician’s recommendations to deem a procedure is warranted. What’s more, performing procedures to “rule out” specific conditions may result in denials if providers fail to submit relevant and detailed documentation to support the reason for the procedure – and this could vary by insurer,. Submitting the required documentation to show medical necessity is key to realizing positive outcomes from a reimbursement standpoint. Understanding what is required by each insurer and having a system in place that speaks to these requirements is crucial to making the case for a procedure to be deemed medically necessary. 

Want to learn more about how your practice can limit its radiology claim denials in order to optimize cash flow? Get in touch with an AdvantEdge expert now, or stay up to date on company and industry trends by visiting our LinkedIn page.