Imaging Center Billing
Medical imaging centers play a critical role in healthcare by providing diagnostic and preventive services through imaging modalities like MRIs, CT scans, X-rays, ultrasounds, and nuclear medicine. However, billing for imaging services is a complex process due to varying insurance policies, strict coding guidelines, and compliance requirements. The uniqueness and challenges of imaging center billing necessitate specialized knowledge and expertise, making it crucial to work with an experienced medical billing company rather than relying solely on an in-house team.
Billing for imaging centers is a highly specialized process that requires expertise in CPT coding, insurance policies, and prior authorization. The complexity of medical necessity documentation, payer-specific guidelines, and claim denials makes it challenging for in-house teams to manage billing efficiently. A professional medical billing company like us offers expertise, efficiency, and compliance assurance, helping imaging centers maximize revenue while minimizing billing errors. By outsourcing billing services to us, imaging centers can streamline operations, improve cash flow, and enhance patient satisfaction.
Unbeatable Service, Quality & Price
ACCURACY
0
%
TURNAROUND TIME
<
0
Hours
COLLECTION
0
%
PRICE
Starting from $
1100
/Month
CHALLENGES
Challenges in Imaging Center Billing
Prior Authorization and Medical Necessity Issues: Many high-cost imaging procedures require prior authorization from insurance companies, which delays claims processing. If prior approval is not obtained, the claim is likely to be denied, leading to revenue loss. Additionally, medical necessity documentation must be accurately recorded and submitted to justify the imaging procedure. Inadequate documentation is a leading cause of claim denials for imaging centers.
Payer-Specific Rules and Compliance: Each insurance payer has unique billing guidelines and reimbursement rates for imaging services. Some common payer-specific challenges include:
- Medicare vs. Commercial Insurance – Medicare requires adherence to the National Correct Coding Initiative (NCCI), while commercial payers may have their own proprietary policies.
- Bundling and Unbundling of Codes – Certain procedures are bundled together under a single CPT code, while others must be billed separately. Incorrect coding can result in claim denials.
- Modifiers – Imaging services often require modifiers (e.g., -26 for professional component, -TC for technical component) to indicate whether the billing is for the physician’s interpretation or the facility’s technical service.
Claim Denials and Revenue Loss: Imaging centers experience high denial rates due to incorrect coding, missing documentation, or lack of prior authorization. Reworking denied claims is a time-consuming process that strains in-house billing teams.
OUR PROCESS
Our Imaging Center Billing Process Workflow
Our workflow process for medical imaging center billing involves several key steps to ensure accurate and timely reimbursement. It begins with patient registration, where we collect complete patient information, including demographics and insurance details. This is followed by eligibility and benefits verification to confirm the patient’s insurance coverage. Once verified, we schedule appointments and document and code the imaging services accurately. Then we submit claims to insurance companies and closely monitor the status of these claims to address any issues or denials promptly.
After claims submission, we record payments received from insurance companies and patients and reconcile them with the billed amounts. During patient billing, we send statements for any remaining balances and offer payment plans if needed. We also carry out follow-ups and collections to manage unpaid claims and patient balances. Finally, through reporting and analysis, we identify areas for improvement and ensure the financial health of the imaging center.
Scheduling & Registration
Carry out well-coordinated appointment scheduling, update insurance details, and handle inbound and outbound calls from/to patients.
Eligibility & Benefits Verification
Confirm primary and secondary insurance and benefits coverage of patients and verify their coverage, co-pays, co-insurance, and deductibles.
Prior Authorization
Initiate request for prior authorization with the payer, follow up to check its status till closure and finally update the system with Auth approval reference number.
Medical Coding
Check the accuracy of codes and modifiers according to specialty and assign corresponding and appropriate charges to the codes.
Charge Posting
Enter the charges for the services provided into the billing system including the cost of the medication and the administration fee.
Claims Edits & Submission
Audit the claims thoroughly to check for accuracy and edit if necessary and submit claims – both EDI and paper format.
Payment Posting
Carry out both auto as well as manual posting for payments received and conduct reconciliation against claims.
Denial Management
Analyze and categorize denial claim according to denial codes, $ amount and payers, and resubmit claims after correction.
AR Management
Follow-up with payers to gather status for unpaid claims, and their resolution.
Patient Collection
Sending patient statements and follow-up with patients for final and outstanding payment.
You can confidently rely on us to manage your entire billing process, or you have the flexibility to select specific DME billing services that suit your needs, ensuring a seamless operation without any interruptions.
BENEFITS
Outcomes Guaranteed
Our structured approach to managing medical imaging center billing provides actionable insights to boost your ROI. We comply with the latest regulations and standards to ensure your center is audit-ready and safeguarded against legal issues. Our team upholds the highest quality standards, guaranteeing significantly improved financial results.
WHY US?
Why partner with us
Partnering with RCM Workshop can significantly benefit your medical imaging center by increasing revenue and speeding up reimbursements through expert coding and claims submission. This partnership would reduce your administrative burdens, allowing staff to focus on patient care and daily operations, thereby improving efficiency and satisfaction. Additionally, our team of billers can ensure compliance with the latest regulations, provide detailed financial reporting, and protect the center from legal issues, ultimately leading to better financial outcomes.