Nuances in Radiology Billing

Posted by mgsionline on November 1st, 2013

One of the specialties in medical insurance billing that requires expert knowledge to handle is undoubtedly radiology billing. The frequent changes in coding and collections regulations have made the already-complicated radiology billing more cumbersome. Similar to other hospital affiliated specialty billing, radiology billing also has some unique requirements that differ from the usual healthcare billing. It is therefore necessary that provider billing staff are trained in the nuances of billing diagnostic radiology for a profitable reimbursement. Now, let’s take a look at these nuances in detail:

Understanding Different Components: While processing radiology billing claims, one must be able to clearly differentiate between the technical and professional components. The medical equipment used for performing radiology and the measurement of its usage are billed under the technical component. The reading of the diagnostic radiology information of patients and listing the findings by the Radiologist is categorized under the professional component.

Global Billing of Diagnostic Radiology:

• When a Healthcare Facility or Provider bills for both technical and professional components, then it is called as global medical billing of diagnostic radiology.
• Radiology global billing is usually performed when radiologists are appointed by a healthcare facility on a permanent payroll basis.
• Both technical and professional components are billed together and sent to the payer.

Independent Billing of Diagnostic Radiology:

• Radiology billing of technical and professional components are performed separately when radiologists working in a healthcare facility are appointed on a contractual basis.
• The healthcare facility is responsible for billing the technical component while the contracted radiologist group takes responsibility for billing the professional component.
• Two claims are processed for a single patient and sent to the payer. To avoid confusion, the radiology group uses Modifier-26, which signifies the billing of professional component. The healthcare facility must use Modifier TC to denote billing of technical component.

RIS PACS: With the growing shortage for radiologists in the US, there is a necessity for implementing RIS (Radiology Information System) and PACS (Picture Archiving and Communication System). Using these technologies, the patient’s radiological data and imagery can be outsourced to radiologists to acquire clinical readings.

Outsourcing Diagnostic Radiology Billing: After reading the aforementioned nuances, one would have clearly understood the complexities involved in billing diagnostic radiology claims. Performing the job in-house with employees who have limited knowledge about radiology billing is a big risk. Therefore, the best risk mitigation option would be to outsource radiology medical billing to a reputed medical billing company.

About MGSI:

When it comes to diagnostic radiology billing, look no further than MGSI. This reliable and reputed medical insurance billing company is based out of Florida, US. With more than 20 years of experience in the domain, it has earned the goodwill of several clients across the US. For more details, log on to www.mgsionline.com.