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How Radiologists Can Refine Their Revenue Cycle Management (RCM) With Radiology Billing Specialists


Medical practitioners, whose immediate concern has been quality patient care or clinical excellence, may be swayed away by a compelling healthcare regulatory compliance. While regulatory compliance may have been designed to rationalize the entire healthcare delivery, optimize medical expenditure, and improve outcomes for patients.

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End to End Medical Billing Solutions

          How Radiologists Can Refine Their Revenue Cycle Management (RCM) With
                                Radiology Billing Specialists
       The emphasis on Revenue Cycle Management could never have been so high as it is now – as radiologists begin to
       comply with of the Affordable Care Act’s (ACA) requirements, they would realize the importance of reinvent their
       billing and revenue cycle management process to suit the bundled care, shared risk, and quality-driven
       reimbursement models. With fee-for-service likely to be phased out in favor of value-based service model,
       radiologists’ revenues may be vulnerable to reductions or long hold-up at the hands of either public plans such as
       Medicare, Medicaid, or commercial payors. In fact, the population health management requires diagnostic
       radiologists to adopt shared-risk model with in a period of five years or so. Therefore, radiologists will be under the
       obligation to coordinate and conform to performance standards for diagnostic services, rendered to both Medicare-
       supported beneficiaries as well as commercial insurance beneficiaries.

       While displaying the requisite level of diagnostic competence may qualify them for value-based reimbursements and
       incentives, it is no guarantee that they automatically get converted to monetary returns unless they have
       substantially modified their medical billing and RCM process to the demands of value-based reimbursement model.
       Notwithstanding radiologists’ internal billing resources, it may not be possible to maneuver through a more
       regulatory payment environment without an exclusive third party diagnostic radiology Revenue Cycle Management
       specialist or specialists. The advantage of having such specialists onboard your Radiology Billing and RCM is that they
       prove catalytic in the entire process of RCM cycle, comprising:

                  •   Credentialing with inclusion of turnkey services, payer enrollment and contracting,
                      credentialing and verification services, state medical licensing services, and personalized
                      attention for individuals or group radiologists

                  •   Patient Access with key demographic patient information – including name, social security
                      number, and insurance coverage – to serves as the foundation for payment of services. It is
                      critical that this information be accurate, and linked to other billing functions from centralized
                      registration or pre-registration systems.

                  •   Accurate and timely charge capture to make sure that all radiology services produce payable
                      claims; it may be remembered that reconciliation of procedures-to-charges will help confirm
                      that an accurate number of claims have been generated.

                  •   Coding powered by automatic and electronic coding of ICD-9 and ICD-10 codes, supervised by
                      trained coders that specialize in CPT, ER and E&M coding

                  •   Billing, complete with electronic claim submission, posting denials and aggressive follow up
                      of delays and denials

                                               Copyright ©-2013 M.D.C.P. All Rights Reserved.
                                                                                                                Page 1 of 2
End to End Medical Billing Solutions

                  •   Collection with emphasis on conversion of older account receivables first and within the
                      permissible time limit.

       As radiologists seek to uplift their revenue fortunes with Radiology Billing Specialists,
       offers to mediate the employment of radiology billing specialists, who are capable of:

                         Keeping reimbursements as per negotiated fee schedules with Medicare, Medicaid, or
                          commercial health insurance carriers
                         Guaranteeing payment contracts as per prevailing market
                         Minimizing A/R days through complete and timely charge capture
                         Enhancing payment accuracy with line-item posting of charges and payments
                         Averting risk through the industry’s most comprehensive compliance program

                                             Copyright ©-2013 M.D.C.P. All Rights Reserved.
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