Medical imaging is a critical component of the modern healthcare system. Medical imaging technology advances, and radiologists now have efficient screening methods for detecting probable health illnesses or diseases, allowing patients to receive adequate and timely medical care. However, claim denials owing to patient eligibility issues continue to be a source of concern for radiology practitioners. The most accessible approach for solving this problem is using insurance eligibility verification services.
Scenario
When a radiology practitioner delivers an error-free claim on schedule, the practice’s cash flow improves and operational costs are reduced. However, you may experience reimbursement delays related to radiology claim denials from the payer for various reasons.
When claims are refused, patient is the first to suffer since the whole burden of repayment lies on the patient’s shoulders. When patients contact the practice’s billing office to complain, the billing office must manage the phone call, investigate the problem, get updated information, and re-submit the claim within the time frame specified.
Medicare Radiology Services
Medicare and commercial insurance companies will reimburse radiology services only if claims include correct information regarding the patient’s eligibility for coverage. Collect precise information about the patient’s eligibility for the treatment to avoid radiology claim denials. At the time of patient registration, health insurance eligibility verification should focus on acquiring information regarding the following:
Information about insurance policies: This entails checking the following items for each patient:
Co-pays and co-insurance
Mailing address for claims
Deductibles
Reimbursable benefits
Healthcare coverage limits
Referrals and pre-authorizations
Out-of-network advantages
It is critical to determine whether the patient has secondary or additional coverage, such as a vision, dental, or accidental injury plan. Secondary health insurance may also be offered to the patient directly or through a partner’s medical coverage. Primary and secondary plans collaborate to provide members with integrated benefits.
Demographic Information
Obtaining demographic information from patient is essential for successful claims. Patient name and ID#, gender, date of birth, Social Security Number, contact details, relationship status, email address, residence address, and current employment. This data must be collected and verified throughout the interaction.
Examine Prior-Authorization Requirements
Radiologist should obtain prior authorization before performing the services, since reimbursements are refused for operations conducted without the requisite authorization.
Pre-authorization may be required for the following radiology exams:
CT Scanners (all diagnostic examinations)
MRA/MRI (all examinations)
Cardiovascular nuclear medicine
PET scanning
Echocardiograms
This Session should begin when the patient registers for an appointment. The front office personnel must acquire as many details concerning the patient’s condition and the reason for the exam as feasible during this process.
Importance of prior authorization to avoid radiology claim denials
The first step in obtaining prior radiology authorizations is to confirm patient coverage. Practice staff must also gather complete information related to the condition of the patient and reasons for the evaluation. Orders for imaging must be suitable and thorough. After obtaining these facts, radiology department or imaging centre personnel can contact referring physician’s office to determine if the referring office has acquired authorization from the insurance provider.
Prior authorization requirements are different for Medicare and Medicaid. Commercially available Medicare Advantage plans differ from standard Medicare coverage and have different submission criteria. Experts would be knowledgeable about these rules to speed on changes in payers’ prior authorization rules and procedures.
Insurance verification and pre-authorization procedure can be time-consuming and necessitates frequent follow-ups. Radiology offices might benefit from collaborating with an expert radiology insurance verification business.
Visit our website to learn more about insurance authorizations, CPT codes, denial codes, and insurance policies or email us at rcmexpertz@gmail.com.
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