Enhancing Billing and Coding Efficiency for a Leading Radiology Group in Los Angeles, CA

This case study explores how Bristol Healthcare Services, Inc. partnered with a leading Radiology Group in Los Angeles to improve their billing and coding efficiency, streamline their revenue cycle, and significantly enhance their bottom line. The group faced numerous challenges, including high claim denial rates, complex coding requirements, and delayed reimbursements. Through a tailored approach—employing cutting-edge technology, certified coders, and proven revenue cycle management strategies—we delivered measurable results, including a 40% reduction in claim denials and a 4% improvement in revenue.

Client Background

Our client is a renowned radiology group with a multi-location presence across the Greater Los Angeles area. The group specializes in a wide array of sub-specialties, including:

• Diagnostic Radiology
• Interventional Radiology
• Nuclear Medicine
• Breast Imaging and Mammography
• Therapeutic Radiology

Despite their success in patient care, the radiology group struggled with managing the complexities of billing and coding for their diverse services. The increasing administrative burden, coupled with frequent coding updates and payer policy changes, prompted them to seek the partnership of a radiology billing service provider to streamline their operations.

The Challenges Faced

1. High Claim Denial Rates

The practice experienced denial rates exceeding 12%, largely due to data entry errors, insufficient documentation and coding errors for complex procedures such as PET scans and interventional radiology. For instance, a significant portion of their claims for high-cost imaging procedures was denied for "lack of medical necessity " causing delays in revenue flow.

2. Difficulty in Managing Prior Authorizations

Many imaging procedures, especially MRIs and CT scans, required prior authorizations. The process was time-consuming, leading to appointment scheduling delays and patient dissatisfaction.

3. Fragmented Revenue Cycle Management

The group lacked a centralized system for accounts receivable (AR) management, resulting in delayed follow-ups, aging claims, and inconsistencies in payment collections.

4. Inconsistent Coding Practices Across Locations

Each location had its own coding process, leading to errors, missed billing opportunities, and non-compliance risks.

The Solutions Implemented

To address these challenges, we implemented a comprehensive solution tailored to the group’s needs:

1. Reducing Claim Denials with Enhanced Documentation and Coding

Our team conducted detailed audits on the denied claims to identify patterns and trained the client’s team on accurate documentation practices. We deployed certified coders with expertise in radiology to ensure accurate and compliant coding for procedures like interventional radiology and PET scans. By improving documentation for medical necessity, we reduced claim denials for PET scans by 70% in the first three months.

2. Streamlining Prior Authorization Processes

We established a dedicated prior authorization team to handle all imaging approvals, leveraging automation tools to accelerate the process. Appointment scheduling delays were reduced by 15%, improving patient satisfaction and throughput.

3. Centralizing Revenue Cycle Management

We introduced an integrated accounts receivable (AR) management system to track, follow up on, and resolve aging claims promptly. We implemented robust denial management workflows to identify root causes and prevent recurring issues.

4. Standardizing Coding Practices Across Locations

Our coders standardized billing processes across all locations, ensuring consistency and compliance. Reducing coding discrepancies across locations by 7% within six months.

The Results We Fetched

By implementing Bristol’s tailored billing and coding solutions, the radiology group experienced a significant transformation in their revenue cycle management and operational efficiency. The results were both quantitative and qualitative, showcasing the power of expertise, technology, and process optimization:

Dramatic Reduction in Claim Denial Rates

The group’s denial rate dropped from 12% to 7%, reflecting a 20% improvement within the first six months.

• Root Cause Analysis Success: Frequent denials for “lack of medical necessity” were addressed by training staff and certified coder to ensure thorough documentation resulting to 2% in this specific denial.
• Improved Clean Claims Rate: Enhanced coding accuracy and data entry increased the percentage of clean claims submitted on the first attempt, reducing the need for resubmissions and appeals.

Significant Revenue Growth

Total practice revenue increased by 10%, amounting to an additional $700K in annual collections. For instance, accurate coding for complex interventional radiology procedures captured previously missed revenue opportunities, contributing an average of $15,000 in additional monthly reimbursements.

Accelerated Prior Authorization Approvals

The dedicated prior authorization team reduced approval processing times by 20%, allowing faster scheduling for procedures such as MRIs, CT scans, and PET scans. Patients benefitted from quicker access to diagnostic services, enhancing satisfaction and loyalty to the practice.

Enhanced Accounts Receivable (AR) Turnaround

AR days were reduced by 25%, improving cash flow and allowing the practice to reinvest in operational growth. For example, claims over 90 days old were reduced by half within the first quarter, with consistent follow-up ensuring timely reimbursements.

Operational Efficiency Gains Across Multiple Locations

By standardizing coding practices, discrepancies between the practice’s locations decreased by 60%, promoting consistency and compliance across all billing processes. Staff productivity increased as administrative teams no longer struggled with complex claim corrections or payer follow-ups.

Comprehensive Reporting and Analytics

Our advanced analytics provided the group with actionable insights into denial trends, payer performance, and cash flow. Regularly delivered custom reports empowered the client to make data-driven decisions, optimizing their operations and revenue strategies.

In Conclusion

By partnering with Bristol Healthcare Services, the Los Angeles Radiology Group transformed its billing operations, overcoming significant challenges and unlocking new revenue opportunities. Our comprehensive solutions demonstrated how outsourcing can not only reduce administrative burdens but also drive measurable financial success.

Why Outsourcing is Beneficial for Radiology Practices

Outsourcing billing and coding to an expert radiology billing company like ours provides numerous advantages.

• Expertise in Complex Coding: Radiology involves intricate coding requirements; certified experts ensure compliance and accuracy.
• Reduced Administrative Burden: Free your staff to focus on patient care by delegating time-consuming billing tasks.
• Faster Reimbursements: Streamlined processes lead to quicker claim approvals and faster revenue realization.
• Cost Savings: Eliminate the need for in-house billing teams and save on training and technology investments.
• Scalability: As your practice grows, outsourced solutions can adapt to accommodate increased volumes seamlessly.

Are you ready to take your radiology practice to the next level? Click the link to explore our end-to-end radiology billing services (or) Contact us today to learn how Bristol can help!