If you have been a radiologist for any length of time, you know that claim pathways are challenging, to say the least. With a third-party payer system, insurance companies are not incentivized to pay what services are worth, and patients are essentially out of the loop when it comes to how much you are paid for your services. A medical billing agency advocates for your practice and ensures your billing process is streamlined and that no billing errors or leaks in the chain result in unnecessary financial loss.
You, as a physician, are not in the business of combing through ICD codes, nor should you be. Your focus is on your patients and staff, as it should be. We partner with radiologists to ensure you get paid for services rendered in an integrable way and through a detail-oriented process. Once an exam is completed, CPT procedures and ICD-10 codes must be applied, then after this already complex process is undertaken, the electronic claim is sent through a clearinghouse to the initial payer (insurer). They respond back with eligibility letting you know if the patient if covered at time of treatment. Now they determine if this is applied to their deductible, partially or fully, how the co-pay is applied, whether or not the procedure is medically necessary and give you an approval or denial. When a denial is returned, additional back and forth is necessary to see if the claim was inappropriately denied – which happens often.
Then, the process gets even more complex. Does the patient have secondary insurance? What federal, state and local laws govern these procedures? Are their insurance-specific or employer-specific policies that additionally complicate billing for the procedure? Claim pathways are designed in the best interest of the insurer, and you need an advocate on your side.
Aptus Medical Billing works with radiologists to ensure your practice is financially efficient. We have the experience that you need and we want to partner with you to make sure your focus remains on your patients. Set up time to talk to us so we can see if our medical billing agency can save you time and money – let’s work together to serve your patients and staff.