Avoid Revenue Leakage: Essential Steps in Your Imaging Center Billing Workflow

The medical billing process has clear steps designed to help you achieve a smooth workflow and improve your financial performance. The crucial steps in your imaging center billing process ranges from patient, registration, insurance verification, documentations to claim submission, payment follow up and payment posting. Any single mistake in your imaging center billing solutions can lead your practice to encounter payment delays, claim denials and revenue leakage at the end a financial year. Fortunately, there are strategies that you can implement to ensure a robust imaging center billing process and seamless cash flow for your practice. 

These are the strategies that an experienced imaging center billing experts use when providing medical billing services: 

Strategies to ensure a robust imaging center billing infrastructure in your imaging center:  

1) Accurate patient data collection:  

Getting accurate and complete details at this stage is essential for everything. Your front-end staff needs to gather the following up-to-date information: 

• Name
• Age
• Address
• Contact number
• Reason for visit
• Medical history
• Medical diagnoses
• Treatment plans
• Medication records
• Insurance payer name
• Policy number
• Allergies 

Making sure this information is accurate is key to providing safe treatments, submitting claims properly, and ensuring smooth billing processes. 

2) Insurance verification:  

After registration, the next step is verifying the patient’s insurance and eligibility before their visit. This is essential to figure out what services the insurance will cover. Since the coverage changes from insurance plan to plan and company to company, hence, you must verify the coverage regularly to avoid any potential surprise. If you find any potential out-of-pocket expense for your patient, you should let them know about in advance to avoid any issue related to miscommunication.  

You can verify insurance by: 

• Contacting the insurance companies directly by phone
• Checking online 

3) Creation of super bills:  

After the patient leaves, all updated info, medical reports, and services provided are put into a single document called the “super bill”. This document includes everything payers need to process the reimbursement. If any information is missing or there’s an error, it can lead to claim denial. 

This is created by the imaging center billing coders in your practice and this includes the information mentioned below:  

• Provider and clinical details
• Patient contact info
• Patient demographics
• Medical history
• List of procedures and services provided
• CPT and ICD-10 codes
• Service dates
• Diagnosis
• Individual service costs along with the total amount of money 

 4) Accurate imaging center coding:  

You need to make sure every procedure, diagnosis, and service given to the patient is correctly and quickly translated into specific medical codes. These codes are part of standardized systems like:  

• Current Procedural Terminology (CPT)
• International Classification of Diseases or ICD-10 coding
• Healthcare Common Procedure Coding System (HCPCS)
• Diagnosis-Related Group (DRG)
• National Drug Code (NDC)  

Ensuring accuracy in medical coding is key to getting the right payments from insurance companies. Using incorrect codes can result in claim denials, delays, and the need to resubmit claims. That’s why you should have certified medical coders who are up-to-date with the latest coding rules, as insurance providers often change their regulations. 

5) Capture charge:  

Charge capture is all about accurately recording every service you provide and entering the total healthcare costs into the billing system. Medical billers track all the medical data and codes along with the correct charges for your services. This information is then used to create claims. If you haven't already, consider using Electronic Health Records (EHR) systems in your practice to ensure accurate data entry and reduce the risk of mistakes. 

6) Claims submission:  

Once your claim is compiled and checked for accuracy, it's time to file it using Electronic Data Transfer (EDI). The process has two steps: 

1. Scrubbing: Your claim form is verified by Electronic Health Record (EHR) software to check for any coding errors or incomplete fields.
2. Clearing House: This is a third-party that acts as a bridge between your practice and insurers. They review patient records, including insurance info, name, date of birth, and any coding issues, then send the claim to the insurance company 

7) Claim adjudication:  

After you file a claim, the insurance payer reviews it to decide whether it is valid or not. There are three states of claims 

• Accepted claims: When your claim is accepted without any coding or data errors, it gets approved. After approval, you’ll receive an Explanation of Benefits (EOB) statement. This statement includes important details like check information, claim number, description of services, the amount your practice billed, and how much the payer covered or didn’t cover.

• Rejected claims: If your claim is missing important information or has a coding mistake, it will be rejected and sent back to you. When this happens, you need to correct the errors and resubmit the claim.

• Denied claims: Your claim might be denied for several reasons, like missing information about the procedure or your practice being out-of-network. For a denied claim, your practice can experience payment delays or revenue loss. If this happens, you can file an appeal with the insurance company or your state's insurance regulators. 

8) Creation of patient statement:  

Create a patient statement that includes the following details: 

• A complete list of procedures and services you provided
• The costs for those services
• Total amount covered by the insurance company
• Out-of-pocket payment for the patients 

You can also include an explanation of benefits (EOB) statement from the insurance provider. This helps the patient see what services are covered and what they need to pay, so they understand why they owe you money even with insurance.

9) Follow up:

The last step is to send out the bills to your patients on time. Make sure they pay their bills by the deadlines you set. If they don’t, you’ll need to follow up. You can reach out to the patient directly or consider hiring a collection agency to help with this process.  

So, now you might have realized that managing imaging center billing solutions is not an easy job as it requires dedicated time, effort and resources. If you want to dodge all the hassles and pitfalls of imaging center billing, outsource imaging centers billing to one of the most popular imaging center billing companies like Sunknowledge. Outsourcing to Sunknowledge allows you to give your utmost attention to clinical care while they allow you to enjoy a substantial revenue boost to your overall revenue.