The radiology physician’s major goal is to receive reimbursement quickly. It can be achieved by error-free claim submission on time. This helps the physician to improve the practice’s cash flow and minimize the overall operational cost. Sometimes, radiology claims are denied due to some reasons. Let us discuss the radiology claims denial reasons and how to avoid them.
Most common reasons for radiology claims denials
- Patient Eligibility Problems
- Lack of Proper Authorization
- Medical necessity
- Insurance plan information etc.
Insurance plan information
If the physician wants to receive full reimbursement, they want to collect the following details properly.
- Name of the plan
- Subscriber ID
- Group number
- Coverage effective date etc.
In case of radiology billing, they have to ensure the following details as well:
Secondary/supplemental coverage details – ensure whether it is patient coverage or spouse’s coverage
Insurance plan information – ensure whether it is a Medicare Advantage plan or a traditional Medicare plan. Depending on the insurance plan, claims will be submitted.
If the patient has Medicaid coverage, physicians have to verify the patient’s ID card, coverage, and effective dates before providing the services.
If the patient has Medicaid managed care plan, claims submitted directly to Medicaid will lead to denial. Avoid such denials by verifying the insurance plan information.
Check for pre-authorization requirements
Radiologists should know which procedures and exams require pre-authorization and inform the patient which procedures requires pre-authorization when they make an appointment or arrive for the exam.
If the services are being rendered by the radiology practice without any prior authorization, it will lead to denials. Claims will also get denied if the submitted claims mismatch between authorization and exams performed.
To avoid radiology claims denials, outsource your radiology billing to leading medical billing company in Florida. MGSI is the best choice. We help you to minimize the denial rate and maximize the billing collections. Contact our medical billing experts to help you to improve your bottom line.
About MGSI
MGSI is a leading Florida based medical billing company; MGSI is the right choice to outsource your radiology medical billing functions. Our company has more than 25 years of experience in providing revenue cycle management services to its clients. We follow expert protocols to get maximum reimbursement from Payers. HIPAA compliant and LIVE Compliance certified, MGSI offers top-notch network and data security. To know more about our medical billing and coding services, visit our website: www.mgsionline.com.