Researchers estimate that imaging utilization will be 16.9% to 26.9% higher by 2055. This huge uptick in imaging service usage opens the door for significant revenue generation. To capitalize on this window, healthcare organizations need to master radiology revenue cycle management.
Our guide moves beyond basic questions like “What is revenue cycle management in healthcare?” and outlines how radiology and pathology RCM can help you overcome high complexity billing. Here’s what you need to know.
When it comes to revenue cycle management, radiology providers must contend with a high claim volume and low margins, which makes billing accuracy critical to maintaining profit margins. Radiology and pathology revenue cycle management decision-makers must also contend with:
Additionally, payers impose heavy prior authorization requirements for advanced imaging, which adds to the administrative burden for radiology revenue cycle management services. Hospital-based and independent imaging models that involve split billing muddy the waters even further.
Radiology healthcare revenue cycle management involves these challenges:
RCM radiology processes are known for high denial rates, which are often linked to:
Radiology revenue cycle solutions aimed at improving denial rates and increasing first-pass approvals can help organizations stop the bleeding. However, healthcare organizations must first identify the root cause of these denials. Is it a coding issue? Do your staff need additional training? Is a payer underperforming?
Radiology and pathology revenue cycle management services can help healthcare entities clear up the mystery surrounding revenue losses.
Underpayments are one of the most frustrating types of RCM radiology challenges. The billing team thinks that they did everything right, and the claim wasn’t rejected. However, when the insurer remits payment, it’s much less than expected. Even minor underpayments can be detrimental to your bottom line if they become a recurring trend.
Capturing data about underpayment trends can help you level the playing field during contract negotiations. However, you need to demonstrate that the issue is systemic and specific to a particular payer.
Many practices don’t have an easy way to see which payers are worsening over time or where payment variances are occurring. That lack of insight leads to silent revenue leakage that’s hard to prove internally.
For your organization to win at radiology revenue cycle management, it must first find a way to justify changes or technology investments to leadership. Better payer analytics helps translate performance issues into measurable financial impact.
Radiology shares many operational realities with pathology RCM. Both face diagnostic complexity and high-volume billing. Payers closely scrutinize the medical necessity of procedures, which creates an entirely different set of headaches.
Without the right medical coding strategies, revenue leakage is going to be the norm. Solving these problems also requires the right tools. When you empower your team with sound strategies, clear policies, and robust technology, it can capture more revenue.
When exploring healthcare revenue cycle management solutions to solve your RCM radiology challenges, make sure that it includes all of the following capabilities:
Your radiology group will benefit from diagnostics that connect reimbursement outcomes to specific codes, payers, and workflows. The right diagnostic tools allow you to conduct a revenue cycle audit and identify where you are leaking money. You can back up your assertions with concrete data that shows what’s happening, where, and why.
Study-level reporting narrows down your focus to specific service lines or modalities. You can pinpoint denial clusters and identify which contracts are paying below expectations. When you bring this information into contract negotiations, you can fight for more favorable terms that support your bottom line.
RCM intelligence tools benchmark reimbursement levels to make contract conversations evidence-based. When your radiology group can measure reimbursement variance and show contract performance relative to expectations, it becomes easier to prioritize renegotiations.
Payer performance intelligence tools also allow you to model the impact of proposed changes on your revenue. You can use this feature to identify which changes are worth fighting for and which ones will not translate to long-term value. Not every discrepancy is worth fighting over, especially when negotiations become heated.
Automation should reduce the manual workload for your team without reducing transparency. Customizable dashboards put actionable insights at your team’s fingertips. At a glance, they can review the latest trends and better understand payer performance in near real-time.
Automating data collection and analytics eliminates the need to wait for month-end reporting. Instead, your team can review trends as they emerge. When a new concern arises, you can address it to minimize revenue losses.
Radiology organizations can’t appeal their way out of systemic problems. While some claims are bound to get denied, minimizing them is the best way to keep revenue high and reduce the need for rework.
An RCM solution helps with this by categorizing denial reasons and linking them to workflow breakdowns. From there, you can prioritize fixes that prevent repeat denials. When denials happen, your team can focus on appealing high-percentage claims that are likely to get overturned.
Download an ebook to learn more about RCM radiology solutions and how they can fit into your revenue strategy.
Solutions like Rivet Health empower you to identify underperforming payers and support contract renegotiation modeling. Our platform solves the problem of silent revenue leakage and improves your forecasting capabilities.
Radiology revenue cycle management requires contract intelligence and deep analytics to improve margins without increasing scan volume. That’s where Rivet Health excels. Our suite of solutions can be customized to suit your needs.
Schedule a demo to learn more.
