Radiology Billing Services
Radiology billing looks simple on the surface. A scan is done. A report is signed. A claim goes out. In reality, imaging revenue lives or dies on technical details. Payer rules change often. Modifiers are unforgiving. One missing indicator can turn a high-value MRI into a zero-dollar denial. For imaging centers and hospital-based radiology groups, billing errors do not just slow payments; they also lead to financial losses. They quietly drain margins month after month.
Radiology practices also operate at high volume. That makes even small error rates dangerous. When hundreds of claims move daily, minor mistakes multiply fast. Medicare-heavy imaging providers feel this pressure the most, especially with NCCI edits, MPFS reductions, and site-of-service scrutiny.
Common Radiology Billing Challenges Practices Face
Incorrect use of -26 and -TC modifiers leading to split-payment denials
Global vs. professional billing confusion between facilities and radiologists
Frequent NCCI edit conflicts for bundled imaging services
Missed documentation for medical necessity under Medicare LCDs
Prior authorization failures for advanced imaging, like MRI, CT, and PET
Place of service mismatches triggering payer audits
Underpayment due to outdated MPFS and RVU values
Delays caused by unsigned or late radiology reports
High denial rates for repeated imaging without proper clinical justification
Precise CPT, ICD-10, and HCPCS coding for diagnostic and interventional imaging. We apply correct global, professional, and technical component rules to protect reimbursement and avoid modifier-related denials.
Clean claim submission for X-ray, CT, MRI, PET, and nuclear medicine studies. Every claim is tracked closely to ensure timely processing and prevent avoidable aging in accounts receivable.
Focused denial management for NCCI edits, medical necessity issues, and modifier conflicts. We analyze denial trends and apply corrections to reduce repeat rejections across imaging payers.
End-to-end support for imaging authorizations and benefit verification. We align approvals with ordered studies to prevent last-minute cancellations and post-service denials.
Accurate posting of Medicare and commercial payments with variance checks. Underpaid imaging services are identified quickly and addressed before balances age out.
HIPAA-compliant billing with reporting built for radiology volume. Dashboards track modality performance, payer behavior, and revenue trends to support smarter decisions.
Radiology billing is not one-size-fits-all. Each imaging subspecialty follows different coverage rules, authorization triggers, and modifier logic. Medicare treats a diagnostic mammogram very differently from an interventional neuroradiology procedure. That is why specialty alignment matters. Our billing workflows are mapped to imaging modality, care setting, and payer behavior, not generic CPT lists. Radiology and Imaging Specialties We Serve
Each specialty is billed with payer-specific logic, correct component separation, and documentation alignment to prevent retroactive denials.
Each imaging modality carries its own reimbursement structure, documentation expectations, and payer scrutiny level. Our teams work daily across diverse imaging environments and service lines.
Diagnostic radiology, including X-ray and fluoroscopy
Ultrasound services across multiple anatomical regions
Advanced imaging such as CT, CTA, MRI, and MRA
Nuclear medicine and PET imaging
Mammography and women’s imaging services
Interventional radiology procedures
Mobile and freestanding imaging centers
Claims are reviewed by modality, site of service, and payer contract requirements before submission.
Radiology practices handle some of the most frequently accessed patient data in healthcare. Images, reports, referrals, and orders move across multiple systems daily. That volume creates risk if compliance is not built into billing operations. HIPAA is not just a legal checkbox. It directly affects trust, audit exposure, and payer confidence.Our radiology billing workflows follow strict HIPAA and HITECH safeguards designed for high-volume imaging environments.
How We Protect Radiology Data
Secure access controls for radiology reports and imaging orders
Role-based permissions for billing, coding, and AR teams
Encrypted data transmission between RIS, PACS, and billing platforms
HIPAA-trained staff handling PHI at every billing stage
Audit-ready documentation trails for Medicare and commercial reviews
Compliance is quietly maintained in the background, keeping practices protected without disrupting workflows.
Radiology practices depend on volume. That makes revenue leakage dangerous. Underpayments, modifier mistakes, or missing technical components can quietly erode margins across hundreds of claims each week. Our revenue integrity reviews focus on what imaging centers lose most often, not what looks obvious.
Revenue Risks We Actively Monitor
Missing technical component billing on facility claims
Underpaid professional fees due to payer fee schedule changes
MPFS reductions affecting imaging-heavy CPTs
Bundled imaging services are incorrectly reimbursed
Repeat imaging denials due to insufficient clinical rationale
Every imaging claim is reviewed with reimbursement accuracy in mind, not just claim acceptance.
Radiology practices operate on speed, accuracy, and volume. Your billing should match that same precision. From diagnostic X-rays to advanced MRI and PET scans, every study deserves clean coding, compliant documentation, and full reimbursement. When billing gaps exist, they compound quickly across hundreds of claims. We step in to protect your revenue without slowing your workflow.
Our radiology billing experts understand modality-specific rules, payer behavior, and Medicare imaging compliance. The result is fewer denials, faster payments, and a predictable cash flow you can rely on.
FAQS
Medicare imaging rules are built into our billing workflows from the start. We apply LCD and NCD medical necessity checks before claims go out. Medicare Advantage plans are handled separately due to their unique authorization and reimbursement behavior. This approach reduces retroactive denials and documentation requests. Practices see more predictable reimbursement cycles as a result.
Authorization tracking is tied directly to ordered studies and dates of service. We verify approvals before claims submission and validate that CPTs billed match the authorization exactly. When payer requirements change, workflows are updated quickly. This reduces post-service denials that imaging centers struggle to appeal successfully. The goal is prevention, not just follow-up.
High-volume environments require strict process control. We focus on clean claim rates, rapid error correction, and daily AR movement. Even small error percentages can cause major revenue loss when volume is high. Our reporting highlights denial trends early, so they do not scale. This keeps cash flow stable without slowing operations.
Payments are posted with variance checks against contracted and Medicare fee schedules. Underpayments are flagged and reviewed individually. We determine whether appeals or corrected claims are appropriate based on payer behavior. This helps recover revenue that is often overlooked. Over time, it improves payer accountability.
Reporting focuses on modality performance, payer trends, denial reasons, and AR aging. Data is presented clearly so leadership can act on it. Imaging-specific metrics help identify which studies perform well financially. This supports better operational and scheduling decisions. Transparency remains a priority throughout the engagement.
Let our medical billing experts optimize your revenue cycle management. We enable healthcare practices to increase cash flow and avoid denials. Permanently!
