Radiology is an important part of healthcare which helps to diagnose the full-body scans of the patients. However, you cannot have a better experience when you are planning to bill for all these advanced scans. Each of these body scans has unique CPT codes, and you can face denials for the smallest mistake. The precision matters for all the bone-scan related radiology billing. Always pay close attention to make sure each CPT code aligns with all the right ICD-10 codes. However, as the healthcare staff stay busy with administrative hassles, that’s why it can be a feasible option to outsource radiology billing solutions in that matter.
A bone scan is a nuclear medicine test where you need to use a handful number of radioactive materials to find problems inside the bone. You perform these procedures to detect infections, cancer, fractures and arthritis. All the radiologists find several problems inside the body part and check if the cancer has spread to a large extent or not. The outsourced radiology billing services know all the complex CPT codes so that clinics don’t face claim denials. The radiologists outsource the whole radiology billing for the full body scan as all the experienced personnel know how to handle all the small billing nuances.
CPT codes are considered the foundation of your billing service. The following are some of the CPT codes used for bone scans:
The clinical teams need to pair each ICD code with the accurate CPT code. However, the payers can deny the claim if you cannot code CPT and ICD code properly. The experienced billing experts know how to match all the physicians' notes with the submitted codes to make sure no claim denial occurs.
The billing process is a complex job as you can bill all the scans in a different way based on the people who provide the service. The in-house team needs to bill globally when the same clinic performs both technical and professional components. The primary modifiers include –26, -59, and TC, but the issue is that you cannot bill both the modifiers together. The rules can be highly confusing, which is why many clinics rely on the outsourced RCM companies to avoid mistakes.
The radiology guidelines change every year, and this year is no exception to it. All the commercial payers and CMS have updated all the billing rules for nuclear medicine scans. Moreover, provide strong medical necessity evidence to streamline accurate documentation procedures to show why you have performed all these scans. Hence, you may end up with claim denials if you cannot provide all the insurers with accurate documents.
The insurers need to get PA approvals for both SPECT and bone scans; otherwise, you won’t get paid for all the necessary services. Using wrong codes, missing approvals, and claim filling deadlines are important reasons why clinics face denials. These billing experts need to file appeals with clinical notes, which states all the patient’s medical needs and corrected codes to make sure no claim denial occurs.
You cannot expect a seamless billing experience with a new team of in-house billing experts to handle all the complex nuances of nuclear medicine scans. Furthermore, you also need to invest a large amount of money and develop and retain an in-house team which can affect the clinic’s cash flow. The outsourced RCM experts for CPT codes use all the advanced tools, updated CPT knowledge track denial patterns to create a streamlined billing workflow.
The outsourced experts stay updated with all the latest CPT, ICD, and HCPCS codes to protect patient data. Moreover, they also know how to streamline the prior authorization process by verifying the patient’s insurance eligibility, collecting important documents, and submitting PA requests to make sure no claim denial occurs. They are also highly cost-effective compared to the in-house team because you don’t need to train them or buy expensive office space for them. They also know how to work with the clinic’s EHR process to store patient data and Electronic Prior Authorization (ePA) procedure to submit claims electronically.