Radiology is two claims. Most practices bill one.
Every study has a professional and a technical component, and who bills which depends on where it was performed and who owns the equipment. Get it wrong and you are paid for half the work.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Radiology claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Professional and technical split wrong
Reading a study you did not perform is a professional only claim. Billed globally, it is recouped later with interest in administrative time.
- Bundling edits not checked
Multiple views, contrast and comparison studies are governed by edits that change. Submitting against last year rules produces steady, quiet denials.
- Prior authorization missing on advanced imaging
MRI, CT and PET routinely need approval. Performed without it, the study is a cost, not a claim.
What we bill for Radiology practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Radiology accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- A radiology coder, not a general one
The coder assigned to your account works radiology every day. They already know which of your payers do what, and they are watching professional and technical splits, bundling edits and contrast rules.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in radiology it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your radiology claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Radiology practices
- Coders who work radiology daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Radiology billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Radiology service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Radiology practices ask
Do you handle teleradiology reads?
Yes, with the correct place of service and professional only billing.
Can you check bundling edits?
Yes, against current edits rather than a saved list.
Who bills the contrast?
Whoever supplied it, and it needs to match the technical component.
Do you manage imaging authorizations?
Yes, ahead of the appointment.
Have a radiology coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.