Radiology Billing Services

Professional and technical components, teleradiology across state lines, and imaging claims that reconcile to the worklist.

Radiology is billed by component, and that is where the money goes missing. A professional read billed without modifier 26. A technical component billed by a facility not enrolled to bill it. A global claim where the practice only owned half. Our radiology billing services match billed studies against the modality worklist, so nothing you read goes unbilled.

Groups weighing up radiology medical billing services should also ask about multi-state cover. With teleradiology, the patient location decides the license and the payer contract. So a group reading for fifteen states needs fifteen sets of enrollments before those claims are payable.

Our Services

Compliance, and the Three Kinds of Radiology

Compliance demands keep rising, so we keep our tools and our knowledge current. We bill interventional, diagnostic and nuclear radiology. Our radiology billing services give your practice a team that handles all three.

Key Attributes of Our Medical Billing Services:

  • Charge Entry

    Your claims come to us and go into our billing software. We hold accuracy above 98% within 24 hours. We get there by automating the routine steps, handling patient data carefully, checking eligibility and chasing insurers quickly.

    Claim Scrubbing

  • Claim Scrubbing

    Every claim is checked for the professional and technical split before it leaves. Modifier 26 goes on the read. TC goes on the claim where you own the equipment. Neither belongs on a global claim. Bill a component you are not enrolled to bill and you get paid, then recouped.

    Insurance and Rejection

  • Insurance and Rejection

    Imaging rejections cluster around three things. An order with no documented indication. A study billed to the wrong contractor. Duplicate claims coming from both the PACS and the RIS. We fix all three at source instead of resubmitting blind.

    Payment Posting

  • Payment Posting

    Payments are posted per component, so the professional and technical halves reconcile separately. That is the only way an imaging centre can tell whether the scanner or the reading is under-recovering.

    Patient Statements

  • Patient Statements

    A patient often gets one bill from the imaging centre and another from the radiologist. Our statements explain that split. It is the most common patient complaint in this specialty.

    Illustration of a doctor writing a prescription for a patient

  • Optimize Efficiency

    We match billed studies against the modality worklist every week. Radiology is where finished work most often goes unbilled. The read happens in one system, and the charge is raised in another.

    Timely Claim Submission

  • Timely Claim Submission

    Reads are billed within 48 hours of sign-off. For teleradiology groups we also check the patient location against the state contract first, because that decides which payer agreement applies.

    Reporting icon

  • Reporting

    Reporting is broken out by modality and by referring facility. That shows you which scanner and which contract are carrying the practice.

    Procedure icon

Procedure

Procedures We Bill Daily

We are accredited across many subfields of radiology, and we bill this work every day. That includes, but is not limited to:

  • Diagnostic Imaging Modalities
  • Fluoroscopy
  • Magnetic Resonance Imaging (MRI)
  • Nuclear Medicine
  • Ultrasound
  • Computed Tomography
  • Interventional Radiology
  • Projection Radiography
  • Tele-Radiology

Components, enrolment and where you are licensed

Radiology billing is decided less by coding than by who owned the equipment, where the patient was, and what the practice is enrolled as.

The component split

Most imaging splits into a professional component, which is the interpretation and the written report, and a technical component, which is the equipment, the film and the staff. A practice that owns the equipment and reads the study bills globally. A group that only reads bills the professional component with its modifier.

This is the single biggest source of silent underpayment in radiology, and it is a setup problem rather than a coding decision, so it repeats on every claim until somebody reconciles payments against expected rates.

Enrolment as a testing facility

A practice performing diagnostic tests for other physicians' patients is generally enrolling as an independent diagnostic testing facility, which is a different enrolment with its own supervision, equipment and personnel requirements. Billing technical components without that enrolment is not a coding error that can be corrected later.

Teleradiology and state licensure

For a remote read, the rules generally follow the patient's location, not the radiologist's. A group reading for hospitals in twelve states needs licensure in those states and payer enrolment in them, and a claim from a state where the radiologist is not licensed is a problem larger than a denial.

Enrolment lead times are the constraint on growth here. A new state contract should start its licensing and enrolment work months before the first study arrives.

Contrast, comparisons and orders

Studies with and without contrast are separate codes, and the report has to say what was given. A comparison with a prior study does not create a separate billable service. And every diagnostic study needs an order from the treating physician with a diagnosis that supports medical necessity: an incomplete order is the most common reason a technically perfect study is not payable.

Radiology Credentialing and Facility Enrollment

Radiology is the one physician specialty where credentialing really is a specialty problem. Teleradiology means reading studies for patients in states you may never visit. The rule is the same as for any telehealth service: the patient location decides the license and the payer contract. A group covering fifteen states needs fifteen licenses and fifteen sets of payer enrollments. That is why telehealth credentialing and radiology credentialing are usually one project.

The second half is facility enrollment. An imaging center that bills the technical component normally enrols as an Independent Diagnostic Testing Facility. Supervision, equipment and staff are all checked, not just claimed. Advanced scanners carry accreditation rules too, and without them the technical component is not payable at all.

We run the multi-state provider enrollment and the facility enrollment together. See our medical credentialing services.