Billing accuracy is essential for radiology professionals. Having the most up-to-date billing information such as codes and modifiers can ensure that all medical services are reported accurately. Your radiology practice can improve procedure details by knowing the most accurate CPT codes for 2024.
CT Tissue Characterization
These are the following CT tissue characterization codes for 2024:
0721T: Quantitative CT tissue characterization, including interpretation and report, obtained without concurrent CT examination of any structure contained in previously acquired diagnostic imaging
0722T: Quantitative CT tissue characterization, including interpretation and report, obtained with concurrent CT examination of any structure contained in previously acquired diagnostic imaging
Quantitative MRCP
These are the quantitative MRCP codes for 2024:
0723T: Quantitative magnetic resonance cholangiopancreatography (QMRCP), including data preparation and transmission, interpretation, and report, obtained without diagnostic magnetic resonance imaging (MRI) examination of the same anatomy during the same session
0724T: QMRCP including data preparation and transmission, interpretation, and report, obtained with MRI examination of the same anatomy during the same session
Percutaneous AV Fistula Creation
For 2024, these are the new percutaneous codes:
36836: Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures when performed, including all vascular access, imaging guidance, and radiologic supervision and interpretation
36837: Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures when performed, including all vascular access, imaging guidance, and radiologic supervision and interpretation
Nerve Injections
These are the injection codes for 2024:
64415: Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including imaging guidance, when performed
64416: Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement) including imaging guidance, when performed
64417: Injection(s), anesthetic agent(s) and/or steroid; axillary nerve, including imaging guidance, when performed
64445: Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, including imaging guidance, when performed
64446: Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement) including imaging guidance, when performed
64447: Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed
64448: Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by catheter (including catheter placement) including imaging guidance, when performed
Radiology Modifiers for 2024
For radiologists, these are the modifiers for 2024:
-95: This modifier indicates the service was telehealth rather than in-office
50: This modifier represents a service or procedure performed on both sides of the body during the same session.
76: This modifier indicates a repeat procedure by the same physician
77: This modifier indicates a repeat procedure by a different physician
A claim denial is a term used when a health insurance company refuses to pay for any medical treatment that was provided. While it can be incredibly frustrating for a patient to get denied healthcare coverage, there may be some valid reasons an insurance company could not accept payment reimbursement. In some cases, a claim denial could change if you figure out the mistake or missing piece of information needed to refile a claim.
What Are the Common Reasons a Claim May Be Denied?
The carrier or insurance company may be unable to cover a form of medical care for many reasons, such as a patient not receiving a professional medical order from a certified provider, or perhaps the medical treatment simply isn’t included in the health insurance plan a patient signed up for. Here are the seven most common reasons a claim may be denied:
Coding mistakes
Lack of pre-approved authorization
Treatment not a medical necessity
Billing claim was filed late
Claim was expired or lost
The care you need isn’t covered in your plan
The provider you used was out of network
#1
Coding Mistakes
Sometimes claims denials could simply come down to incorrect coding. This is why having a system in place to accurately report medical billing is essential, as it can minimize claim denials and unnecessary costs for patients. If this is the reason your claim is denied, it could easily be corrected by resubmitting the claim with the correct codes. You should be careful not to allow coding mistakes to become a habit because it might trigger a fraud audit.
#2
No Pre-Approved Authorization
If you require hospitalization, surgery, medications, or other care for a health condition, you will need a certified medical professional to approve the treatment plan. If a patient seeks treatment on their own without medical approval, most insurance companies will not accept the charges.
#3
Criteria for Medical Necessity Weren’t Met
Sometimes a doctor may approve treatment, but then the insurance company will disagree with the approval and deem certain treatments unnecessary for some patients. Usually, these companies have a certain list of criteria that need to be met before an operation or treatment can be deemed medically necessary.
#4
Late Claim Filing
In some instances, timing may be the biggest factor for a claim being denied. Insurance companies will not pay for medical bills that were claimed too long after the treatment was provided. Typically, the window of time provided is 30 to 90 days.
#5
Lost or Expired Claim
Sometimes it isn’t a patient or medical provider’s fault for a claim being denied. Mistakes happen, and the insurance company may have simply lost a claim and only rediscovered it when it was too late. If this happens, a new claim will need to be made from a medical provider to ensure accurate payment.
#6
Insurance Plan Doesn’t Cover the Procedure
Some kinds of medical care may not be covered in an insurance plan. Patients and providers should always confirm with insurance providers that the care needed is covered before undergoing any major medical interventions to avoid out-of-pocket expenses.
#7
Out-Of-Network Healthcare Provider
If a patient uses a medical service or facility not included in their insurance plan, a claim could be denied due to it being out-of-network care. Patients should always confirm before receiving care if their provider is listed in the insurance company’s network.
What Should You Do if a Patient’s Claim Is Denied?
If your practice keeps having patients’ claims denied, you may require a more robust medical billing system to keep a set of checks and balances organized. This could include minimizing coding errors, ensuring timely billing, and adhering to compliance processes to ensure your patients aren’t overbilled and that your medical practice gets reimbursed correctly for the services provided.
Medical billing is a widely-used term for the simple process of submitting billing claims to a patient after they have received medical care, and then following up on those claims to insurance companies until they have been paid to the medical provider. The remaining balance from the insurance companies will then be billed to the patient who received the care until the facility that performed the work is adequately reimbursed for their services.
What Is the Downside of Traditional Medical Billing?
While the process of medical billing may seem straightforward on the surface, it doesn’t typically give organizations a broader view of revenue cycles or a company’s financial stability. It can also be slow and tedious, requiring the entire medical billing staff to organize and implement effectively. To streamline this process and improve processing procedures, many healthcare practices have turned to RCM (revenue cycle management) tools to increase billing accuracy and overall earning potential.
What Is Revenue Cycle Management (RCM)?
Revenue cycle management (RCM) encompasses all of the financial processes involved with a patient’s medical appointment. RCM is highly detailed, organized, and efficient throughout the complexities of medical billing. These tools therefore can give healthcare providers a better look into the flow of money involved for each party involved in the collections process. Some financial transactions that RCM helps to administer include:
Payer contracting
Coding
Medical collections
Provider enrollment
Management
Compliance
Analytics
What Are the Four Key Steps of RCM?
RCM can go above and beyond what typical medical billing can do. To capture the revenue cycle management process at a higher level, here are the four key steps involved in the payment processing system.
Step #1: Capture Patient Payments
After a patient leaves a medical facility, it can sometimes be difficult to receive a payment from them. It may seem like a simple step in the process, but having an automated tool or outsourced team to help record each payment can improve the individual collection system for patients. RCM systems can train staff on how to properly collect payments from patients or even set up an online payment system to make it easier for patients to access.
Step #2: Receive Insurance Collections
Insurance collections are a part of the process that is similar to traditional medical billing that most organizations are familiar with. Revenue collection management can ensure that all insurance claims are accurately processed, and if any denials in payment come through, they can be resubmitted. This process helps confirm that the services have been coded correctly for all parties involved.
Step #3: Generate Revenue for Your Facility
To keep the lights on and healthcare workers paid fairly, you will need to generate revenue for your facility. As patients in the public use your services, each service (or outsourced, contracted service) needs to be credentialed or coded correctly so all revenue streams from insurance companies to individual patients can be processed effectively.
Step #4: Improve Processes With Accurate Reporting
The last step is procedural adjustment and reporting. RCM takes medical billing further by going through the small details and personalized patient adjustments so they can be reported seamlessly. This reporting saves healthcare staff time and can help bring in additional revenue to a healthcare facility.
Is RCM Right for My Practice?
If your healthcare practice is a small facility with minimal patients and staff, you may not need a robust billing system such as RCM. Traditional medical billing may suit your practice’s needs just as well. However, if you operate a large healthcare facility with many moving pieces involved in patient care, an RCM can drastically improve billing processes and put you in better financial shape for the future.
Hi there, my name is Adam Nager. I’m the Chief Executive Officer and co-founder of Quest National Services.
What Is Quest National Services?
We’re a national, full-practice management revenue cycle management billing service. We cater to clients throughout the United States and almost 50 states nationwide.
Medical Billing for Our Clients
Quest National serves clients like publicly traded organizations, non-profit healthcare organizations, as well as 100 million dollar plus organizations throughout the country.
Quest’s Healthcare Mission
We have over 3000 people that work within our team all focused on billing and providing transparency to your cash flow.
When managing a medical practice, financial health and operational efficiency rely heavily on accurate, timely billing. Partnering with a medical billing service that prioritizes excellence ensures you stay compliant, maintain cash flow, and reduce administrative burdens. Quest National Services sets itself apart by adhering to the highest industry standards. Here’s how our commitment to quality helps your practice succeed.
Achieving Industry Benchmarks for Financial Performance
Achieving industry benchmarks is crucial for your practice’s long-term success. Quest National Services helps ensure your accounts receivable, collections, and denial rates align with or surpass MGMA (Medical Group Management Association) standards, giving you confidence that your financial operations meet industry expectations.
Optimized Revenue Cycle
An optimized revenue cycle improves cash flow and overall financial health. Quest National Services evaluates every aspect of your billing process, from claim submission to reimbursement, identifying areas for improvement to ensure faster payments and increased profitability.
Minimizing Claim Denials and Rejections
Denied claims can disrupt your revenue flow and increase your administrative workload. Quest National Services prioritizes accurate billing and coding to minimize the risk of denials, so your practice can focus on growth rather than resubmitting claims.
Accurate Billing and Coding Practices
By ensuring that claims are properly coded and documented from the outset, Quest National Services helps reduce costly rejections. Their expertise in coding compliance ensures claims are processed smoothly, leading to faster approvals and fewer corrections.
Efficient Authorization and Eligibility Management
Authorization and eligibility issues are common causes of claim rejections. Quest ensures that all necessary verifications are completed correctly the first time, reducing the risk of denied claims due to administrative errors and ensuring a more seamless patient experience.
Ensuring Compliance With Industry Standards
Maintaining compliance in an ever-changing regulatory landscape can be overwhelming. Quest National Services keeps your practice up to date with industry regulations, helping you avoid fines, audits, and other legal risks.
Expert Compliance Support
Quest’s billing team is well-versed in federal and state regulations, payer requirements, and medical coding updates. This expertise helps protect your practice from compliance issues and ensures adherence to legal and contractual obligations.
Stay Informed With Timely Communication
Staying updated on billing progress and potential issues is vital for maintaining control over your revenue cycle. Quest National Services provides regular updates and transparent reporting to keep you informed every step of the way.
Proactive Updates and Detailed Reports
Frequent communication and detailed reports provide valuable insights into your practice’s financial health. This level of transparency allows you to identify trends, address potential challenges early, and make informed financial decisions.
Educational Support for Your Team
Understanding the reasons behind claim denials and rejections empowers your team to make informed decisions. Quest National Services not only handles billing but also provides valuable feedback to help your team improve internal processes.
Training and Feedback for Process Improvement
By explaining the root causes of denials and providing actionable insights, Quest helps your team make adjustments that lead to long-term improvements. This collaborative approach reduces errors and strengthens your billing operations.
Customized Billing Solutions
Every medical practice has unique needs, and a one-size-fits-all billing solution rarely leads to optimal results. Quest National Services offers tailored billing strategies that align with your specific goals, specialty, and growth plans.
Adaptable Solutions for Growth
Quest’s services scale with your practice, whether you’re adding new locations, expanding your services, or navigating a changing patient base. Their customized approach ensures that your billing system remains efficient, no matter the size or complexity of your operations.
Improved Cash Flow and Faster Reimbursements
Maintaining consistent cash flow is essential for covering operational expenses and investing in growth. Quest National Services focuses on submitting clean claims quickly, leading to faster reimbursements and a more stable financial foundation.
Streamlined Billing Processes
Quest’s team works to streamline your billing workflows, reducing delays and bottlenecks. This ensures that reimbursements are received promptly, improving cash flow and giving your practice the financial flexibility to focus on delivering quality patient care.
Dedicated Support Team for Immediate Assistance
Billing issues can arise at any time and require prompt attention. Quest National Services provides a dedicated support team that is available to address your concerns and resolve challenges as they occur.
Responsive and Reliable Assistance
With a knowledgeable team just a call or email away, you can rest assured that your billing concerns will be addressed quickly. This reduces downtime, prevents billing disruptions, and ensures your practice stays on track financially.
Data-Driven Insights for Strategic Decisions
Accurate data is crucial for making informed financial decisions. Quest National Services provides comprehensive reports and analytics to give you a clearer picture of your practice’s financial performance.
Detailed Financial Reporting
Quest’s data-driven reports highlight trends, identify areas for improvement, and provide actionable insights. By understanding your financial performance, you can implement strategies that lead to sustainable growth.
Scalable Services for Long-Term Growth
As your practice grows, your billing needs will become more complex. Quest National Services offers scalable solutions designed to grow with you, ensuring that your billing processes remain efficient regardless of size or scope.
Flexible Billing Solutions
Whether you’re adding new providers, locations, or services, Quest’s adaptable solutions ensure your billing system continues to operate at peak efficiency. Their flexible approach supports your growth without compromising performance.
Reliable Partnership With Transparency
A strong partnership with a trusted billing service provider can make a significant difference in your practice’s success. Quest National Services fosters a collaborative, transparent relationship that ensures you always know the status of your financial operations.
Building Trust Through Transparency
Quest’s commitment to transparency means you’ll receive clear communication, detailed reports, and proactive updates. This builds trust and strengthens your confidence in their ability to support your practice’s long-term goals.
Focus on Patient Care by Reducing Administrative Burden
Outsourcing your billing operations to Quest allows your team to spend less time on administrative tasks and more time on patient care. This not only improves patient satisfaction but also reduces the risk of staff burnout.
More Time for What Matters Most
By handling the complexities of medical billing, Quest frees up your internal team to focus on delivering exceptional patient care. This improves overall practice efficiency and enhances the patient experience.
Minimized Financial Risk
Financial instability can have serious consequences for your practice. Quest National Services minimizes your financial risk by adhering to proven billing standards and best practices, ensuring a steady revenue stream.
Protection From Revenue Loss
With accurate billing, proactive denial management, and adherence to industry regulations, Quest helps safeguard your practice from revenue disruptions and financial setbacks.
Competitive Advantage in the Healthcare Market
A strong financial foundation can set your practice apart from competitors. Quest National Services helps strengthen your practice’s financial health, making it easier to invest in technology, staff, and expanded services.
Investing in Growth and Innovation
With more predictable revenue and faster reimbursements, your practice can reinvest in areas that improve patient outcomes and enhance your competitive edge. This positions your practice as a leader in the healthcare market.
Continuous Improvement for Long-Term Success
Quest National Services is committed to continuous improvement, ensuring that your billing processes remain efficient and compliant with industry changes. This proactive approach helps your practice stay ahead of the curve.
Ongoing Service Enhancements
Through regular process updates, technology improvements, and compliance checks, Quest ensures that your billing system evolves with the industry. This keeps your practice agile and resilient in a dynamic healthcare environment.
Working with a medical billing solution provider that is HIPAA compliant is of utmost importance to you as a practice owner. The implications of not working in a HIPAA-compliant manner can impact your cash flow, and your practice, and can potentially shut down a practice if not done properly.
How Quest National Services Stays HIPAA Compliant
We want to make sure that all practices are staying compliant and are out of willful neglect and are doing regular and consistent security risk assessments to ensure their compliance. We, ourselves, utilize a solution provider that assists us through the process of maintaining our compliance.
How Do We Want Our Clients To Stay HIPAA Compliant?
We recommend our clients do the exact same thing to avoid hefty fines and potential litigation.
Working with a publicly traded company in 2022, we started by ensuring that each one of the diagnosis codes provided to us was applicable to each of the CPT codes that were going to get billed out.
Accurate Billing Reduces Claim Denials
Doing this eliminated any distractions and eliminated any reason for a denial to happen. With that, combined with our eligibility verification services, we ensured that each patient was actually eligible prior to submitting the claim and prior to that patient being seen, ensuring that each claim would get paid timely and properly for this publicly traded organization.
Testing Claims for Accuracy
Prior to us getting involved, 95% of this client’s claims were actually getting rejected for numerous different reasons. Prior to us even actually starting the process of routinely and regularly filing the claims for this particular group, we ensured that we submitted a test run of claims, ensuring that claims got paid timely and properly the first time.
Aiming for MGMA Standards
Over the past 15 years, we’ve ensured 90+% of all clients we’ve brought on have met these same expectations and standards. We’re going after those MGMA standards every day.
We’re in Business To Maximize Collections
Every dollar counts. That’s why we started the business and that’s why we’re still in this business today.
The biggest advantage we offer is that we are a one-stop shop for all of your healthcare needs. 15 years ago when I got started in this industry, I was out there to assist my clients with any needs that they may have had that made sense to our organization.
The Growth of Quest National Services
Today, we own seven companies, all centered around healthcare practices and healthcare organizations throughout the country and we serve our clients in a variety of different needs.
Advantages of a One-Stop Shop
That allows our clients to focus on what they do best, allowing us to focus on the back side of that office. From financial health care management to contracting credentialing, rate negotiation, and virtual assistance to help run the practice, both the front end and the back end, we are there to support our clients in every need. From HIPAA consulting and compliance to marketing, website management, and even EMR implementation, we’re there for our clients.
How We Compare to Our Competitors
Most of our other competitors are really good in one area, maybe billing, maybe consulting, maybe marketing, etc. We try to take everything under one umbrella and support our clients with each one of their needs. We’ve got a phenomenal billing team, many of whom have been with us for over 5 years. There are over 20 years of experience in our average biller and our average manager.
The Importance of Communication
Transparency, collaboration, and communication are of utmost importance to us. We’re going to communicate on a regular, consistent basis with you. That translates to each and every one of our other departments and other companies that I own throughout healthcare.
Communication With Our Clients
From marketing, we’re going to communicate extensively with you and ensure that you know exactly where we are every step of the way. Same with contracting credentialing. We want to make sure you know exactly where we are. It’s a tedious process that takes a lot of time.
Communication Sets Us Apart
We want to make sure that you know exactly where we are at every step of the process. That really does set us apart in the community.
A One-Stop Shop Means Faster Turnaround Times
The benefit of working with one umbrella company like ours is that we’re able to negotiate a little more aggressively when you utilize multiple service lines. In addition to that, the communication between those organizations that we own really helps translate into faster turnaround times across the board, whether it be credentialing, billing, marketing, etc.
Easy Collaboration Makes Turnaround Times Faster
Why? Because one organization is feeding the others information, we’re able to collaborate and therefore translate it into faster turnaround times for your organization.
By outsourcing medical billing to a professional service, you can streamline operations, reduce administrative burdens, optimize your practice’s financial health, and ensure compliance with industry standards, allowing you to focus on delivering quality patient care.
1. Reduces Administrative Burden
According to the Medical Group Management Association (MGMA), outsourcing medical billing services can reduce administrative tasks by up to 50%, allowing staff to focus more on patient care.
Managing in-house billing requires extensive time and effort from your staff, pulling them away from patient care and essential administrative duties. By outsourcing to a professional medical billing service, your team can focus on providing high-quality healthcare rather than chasing down payments or managing claim submissions. With experts handling billing tasks, your practice benefits from improved efficiency and a more patient-centric approach to operations.
2. Improves Cash Flow
According to the Healthcare Financial Management Association (HFMA), outsourcing medical billing can accelerate reimbursements by up to 30%, improving cash flow by reducing claim denials and payment delays.
A streamlined billing process ensures that claims are submitted accurately and on time, leading to faster reimbursements and a more consistent revenue stream. Professional medical billing services use efficient systems to track payments, follow up on outstanding claims, and reduce delays caused by errors. By improving cash flow, your practice can better manage operational expenses and reinvest in patient care.
3. Minimizes Errors
A study by the American Medical Association (AMA) found that outsourcing medical billing can reduce billing errors by up to 25%, leading to fewer claim rejections and faster reimbursements.
Billing and coding errors are among the leading causes of claim denials and delayed reimbursements. Professional medical billing services like Quest National Services employ trained specialists who understand complex coding systems and insurance requirements, reducing the likelihood of mistakes. Accurate claims submission not only accelerates payments but also minimizes the administrative burden of reworking denied claims.
4. Ensures Compliance
According to the Medical Group Management Association (MGMA), outsourcing medical billing ensures compliance with evolving regulations by engaging experts who stay current with the latest coding and billing standards, thereby reducing errors and enhancing financial performance.
Medical billing is subject to strict regulations, including HIPAA compliance and evolving insurance policies. A professional billing service stays updated on the latest industry standards and regulatory requirements, ensuring that your practice remains in full compliance. By outsourcing, you reduce the risk of penalties, audits, and legal complications associated with improper billing practices.
5. Access to Expertise
Outsourcing medical billing connects practices with experienced billing professionals, which, according to the American Academy of Professional Coders (AAPC), can improve coding accuracy and boost reimbursements by up to 20%.
Navigating the complexities of medical billing requires specialized knowledge that may be difficult to maintain in-house. Outsourcing to experts in the field provides your practice with access to experienced billing professionals who are well-versed in insurance policies, coding updates, and best practices. Their expertise helps improve accuracy, efficiency, and overall revenue management.
6. Accelerates Claim Processing
The Medical Group Management Association (MGMA) states that outsourcing medical billing can speed up claim processing by as much as 30%, reducing delays and ensuring faster payments.
Slow claim processing can lead to cash flow disruptions and financial strain. Professional medical billing services use advanced software and systematic processes to ensure that claims are submitted quickly and correctly. They also follow up on unpaid claims promptly, reducing turnaround time and keeping your revenue cycle moving smoothly.
7. Enhances Revenue Cycle Management
According to the Healthcare Financial Management Association (HFMA), effective revenue cycle management can increase collections by up to 15%, making outsourced medical billing a strategic solution for maximizing practice revenue.
A well-managed revenue cycle is essential for maintaining financial stability in your practice. Professional billing services optimize every stage of the billing process, from patient eligibility verification to payment posting. By streamlining operations, reducing errors, and improving collections, outsourced billing services help maximize revenue and minimize financial gaps.
8. Decreases Overhead Costs
The Medical Group Management Association (MGMA) reports that outsourcing medical billing can reduce overhead costs by up to 40%, minimizing expenses related to in-house billing staff, training, and technology.
Maintaining an in-house billing team comes with significant costs, including salaries, benefits, training, and software expenses. Outsourcing eliminates these overhead costs by shifting the responsibility to a dedicated billing provider. With professional medical billing services handling your revenue cycle, your practice can allocate resources more efficiently while reducing operational expenses.
9. Scalable Solutions
According to AAA Medical Billing, outsourcing medical billing offers scalable solutions that allow practices to handle increased billing volumes without disrupting operations, ensuring efficiency and consistent cash flow.
As your practice grows, so do your billing needs. Outsourced medical billing services offer scalable solutions that can adapt to fluctuations in patient volume, insurance changes, and regulatory updates. Whether your practice expands or experiences seasonal variations, a professional billing provider can adjust services to meet your evolving demands.
10. Provides Advanced Technology
According to the Medical Group Management Association (MGMA), outsourcing medical billing provides healthcare practices with access to advanced technology, enhancing efficiency and ensuring compliance with the latest regulations.
Professional medical billing services like Quest National Services utilize cutting-edge billing software and automation tools to enhance accuracy and efficiency. These technologies streamline claim submissions, track outstanding balances, and integrate with electronic health record (EHR) systems. By leveraging advanced technology, your practice benefits from faster, more precise billing processes.
11. Offers Detailed Reporting
According to the American Academy of Professional Coders (AAPC), outsourcing medical billing provides healthcare practices with detailed reporting and regular updates, enabling them to monitor financial performance and identify areas for improvement.
Data-driven decision-making is crucial for financial success. Outsourced billing services provide comprehensive reports that offer insights into claim statuses, revenue trends, and potential areas for improvement. With access to detailed financial analytics, practice managers can make informed decisions to optimize operations and enhance profitability.
12. Facilitates Seamless Transitions
Transitioning from in-house to outsourced medical billing can lead to revenue increases ranging from 11.6% to 20%, as reported by the Medical Group Management Association (MGMA) and Altrust Services, respectively.
Switching from in-house billing to an outsourced service can be a concern for many practices. However, professional billing services ensure a smooth transition by integrating with your existing systems, training staff on new processes, and maintaining cash flow stability during the changeover. This minimizes disruptions and allows for continued operational efficiency.
13. Continuous Support
Continuous support from a medical billing company can lead to a 15-25% improvement in overall revenue collection for healthcare practices, as reported by ZipDo.
Billing issues can arise at any time, requiring prompt resolution to prevent revenue loss. Professional billing services offer ongoing support to address claim rejections, patient billing inquiries, and insurance disputes. With a dedicated team available to assist, your practice can maintain efficiency and avoid delays in reimbursements.
14. Reduces Revenue Loss Risks
According to the American Academy of Professional Coders (AAPC), outsourcing medical billing can mitigate revenue loss by ensuring accurate coding and timely claim submissions, thereby reducing denials and enhancing cash flow.
Denied claims, coding errors, and missed follow-ups can lead to substantial revenue losses. Outsourcing to a professional medical billing service helps mitigate these risks by implementing best practices for claim submission, tracking outstanding payments, and ensuring compliance with industry standards. A proactive approach to billing protects your practice’s financial health.
15. Streamlines Workflow
According to the Journal of Medical Practice Management, outsourcing medical billing achieves an 80% first submission payment rate, surpassing the 68% rate of in-house billing, thereby streamlining workflow and enhancing efficiency.
Handling billing in-house often leads to workflow bottlenecks and administrative inefficiencies. By outsourcing, your practice can integrate billing processes seamlessly with scheduling, patient records, and insurance verification. This cohesive approach eliminates redundancies, reduces administrative strain, and improves overall operational flow.
16. Enhances Accuracy
According to the American Academy of Professional Coders (AAPC), outsourcing medical billing enhances accuracy by providing access to specialized expertise, leading to improved coding precision and compliance.
Precision in medical billing is critical for maximizing reimbursements and maintaining positive relationships with insurance providers. Professional billing services prioritize accuracy through detailed claim reviews, proper coding, and compliance checks. With fewer errors, your practice experiences fewer denials and a smoother revenue cycle.
17. Focus on Core Activities
Outsourcing medical billing can reduce administrative tasks by up to 50%, allowing staff to focus more on patient care, as reported by the Medical Group Management Association (MGMA).
Balancing patient care with administrative tasks can be challenging for medical practices. By outsourcing billing, your team can devote more time to patient engagement, treatment planning, and practice growth. A professional billing service takes the burden off your staff, allowing them to focus on what truly matters—providing excellent healthcare.
18. Improves Patient Satisfaction
According to the Medical Group Management Association (MGMA), outsourcing medical billing can enhance patient satisfaction by improving the financial experience through standardized revenue cycle management processes, leading to greater transparency and convenience for patients.
Billing transparency and efficiency contribute to a better patient experience. Faster claim processing, accurate statements, and flexible payment options help reduce patient frustration. With a professional billing service handling these aspects, your practice can foster positive patient relationships and improve overall satisfaction.
19. Flexible Contract Terms
Flexible contract terms with an outsourced medical billing company can reduce operational costs by up to 30-40%, as healthcare facilities often spend this portion of their revenue on in-house billing processes.
Every practice has unique billing needs, and professional billing services offer flexible contract options to accommodate those requirements. Whether you need full-service billing support or specific services, outsourcing providers can tailor solutions to fit your practice’s goals and financial strategy.
20. Access to Industry Insights
According to the Medical Group Management Association (MGMA), outsourcing medical billing provides healthcare practices with access to specialized expertise, ensuring accurate coding and compliance with the latest regulations, which can enhance financial performance and operational efficiency.
Staying ahead of industry trends and regulatory changes is crucial for maintaining a successful practice. Professional medical billing services like Quest National Services provide valuable insights based on data analysis, payer trends, and emerging technologies. Leveraging this knowledge allows your practice to optimize its revenue cycle and adapt to industry shifts effectively.
Avoiding Pitfalls When Switching Billing Services
Transitioning to a new medical billing service can offer significant benefits, but it also comes with challenges that, if not handled properly, can disrupt cash flow and negatively impact your practice. The key to a smooth transition is understanding potential pitfalls and implementing a structured plan to mitigate risks.
Risk of Revenue Loss During Transition
One of the biggest risks when switching from an in-house billing system or an existing billing service to an outsourced provider is temporary revenue disruption. If the transition is not carefully managed, delays in claims processing and payment collection can create cash flow shortages, making it difficult for practices to cover expenses such as rent, payroll, and equipment leases.
The Long-Term Impact of Poorly Managed Transitions
A poorly executed transition can have lasting financial consequences. If claims go unprocessed or payments are delayed, the financial strain can impact not only physicians but also practice owners and staff. A short-term cash flow issue can quickly escalate into a long-term problem, jeopardizing the financial stability of the practice. That’s why careful planning and coordination are essential when transitioning to a new billing provider.
Creating a Seamless Transition Plan
To prevent revenue loss, it’s crucial to implement a structured transition plan that clearly defines key milestones. This plan should outline:
The exact date when the new billing service will take over
A detailed timeline for data migration, training, and system setup
The expected deliverables from the new billing provider
How the existing billing team or service will continue operations until the go-live date
By ensuring that both the outgoing and incoming billing teams collaborate during the transition, your practice can maintain a steady cash flow throughout the process.
Common Transition Issues and How To Avoid Them
One of the most common mistakes in billing service transitions is a gap between the old and new billing systems. For example, if the previous billing provider stops working on June 30th and the new billing service starts on July 1st, but EDI (Electronic Data Interchange) enrollments haven’t been properly completed, claims processing can be delayed, causing significant cash flow problems.
To prevent this, your practice should ensure that all necessary integrations, such as Clearinghouse EDI enrollments and payer connections, are in place before the transition occurs. Testing and verifying that claims can be processed successfully before the go-live date will help avoid costly disruptions.
Ensuring a Smooth Billing Service Transition
A successful transition requires careful planning, testing, and communication. Before going live with a new billing service, make sure:
EDI enrollments and clearinghouse connections are properly configured.
The new billing software has been thoroughly tested.
Staff and providers are fully trained on the new system.
Standard Operating Procedures (SOPs) are documented and ready to implement.
The new billing service provider is prepared to handle claims immediately.
By taking these proactive steps, your practice can avoid revenue loss, minimize disruptions, and ensure a smooth transition to a professional billing service like Quest National Services. A well-planned switch not only preserves financial stability but also positions your practice for improved billing efficiency and long-term success.
Accurate claim filing not only helps to maximize your collections but also helps to protect you from the risk of audits. The more accurate the codes are, the more collections you can claim. Make sure that you know the latest oncology codes and their modifiers so you can
Oncology CPT Code Ranges for 2023
See the oncology center CPT updates for 2023:
77427 – radiation oncology physician management
81449 – targeted genomic sequence analysis
87468 – infectious agent detections
81418 – drug metabolism analysis using a genomic sequence
Oncology CPT Modifiers
CPT codes alongside any modifiers can improve the overall accuracy of medical billing. These are the updated oncology modifiers for 2023.
FQ – service with audio-only communication
FR – provider was present with audio-visual technology
