Radiology billing and accounts receivable

Component billing, prior authorization for advanced imaging, and appropriate-use criteria shape the whole revenue cycle.

Where the money leaks in radiology

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Advanced imaging denied for missing prior authorization
• Appropriate Use Criteria consultation not recorded
• Professional and technical components billed by the wrong entity
• Contrast and non-contrast studies coded from the wrong descriptor
• Duplicate studies inside a payer's frequency window

What a seat does about it

One trained person works your queue from the difficult end. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing.

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and certified coding at $2,500.

The codes those turn into

Each of these is a denial code you are likely to meet working radiology, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-197 — Prior authorization absent
  The payer required prior authorization for this service and cannot find one attached to the claim.
  Recovered by being taken back to the authorization. Matched from: “Advanced imaging denied for missing prior authorization”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and about about 90% of initially denied claims are eventually paid. Most of what sits in a radiology AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions