Radiology is a key component of modern healthcare, providing invaluable insights into patients’ conditions. Although essential, there is a massive challenge that providers face that has multiple consequences for both patients and the healthcare facility.
Underbilling in Radiology
Underbilling in radiology occurs when the full scope of services provided by radiologists and imaging facilities is not accurately represented in billing submissions. For example, when a routine Head CT is ordered and there is something seen, the radiologist requests contrast be added to the exam. With a busy department the tech forgets to add contrast to the order, and it gets reimbursed without contrast, thus leaving potential revenues behind. While it may seem like a mere administrative hiccup, the repercussions are profound and extend far beyond the realm of administrative duties.
Impact on Healthcare Facilities
Financial Shortfall: Underbilling leads to financial losses for healthcare facilities. When services are not correctly billed for, the facility misses out on revenue that is essential for operational sustainability and investment in patient care. This can add up significantly, estimates put this at $280,000 per year for many facilities.
Operational Disruption: Dealing with underbilling cases demands administrative resources, diverting staff attention away from essential tasks such as quality improvement initiatives, and operational efficiency. Staff must correlate the actual study against what was coded and fix any discrepancies, thus requiring substantial amounts of time.
Resource Allocation Challenges: Underbilling can disrupt budget planning and resource allocation and reflect inaccurate statistics on performance. Healthcare facilities may face constraints in upgrading equipment, hiring additional staff, or expanding services due to financial constraints. With an underestimation of services provided, annual planning is inaccurate.
Compliance Risks: Inaccurate billing records can raise compliance concerns. Healthcare facilities must ensure adherence to billing regulations and standards, as deviations may result in penalties, audits, or reputational damage. Reimbursement fraud charges are common for something that could be preventable.
Diminished Quality of Care: The underbilling issue may hint at broader operational inefficiencies within the healthcare facility. This can erode patient confidence in the quality of care received, potentially affecting patient satisfaction and retention.
Impact on Patients
Financial Burden: Patients may find themselves bearing the financial burden of underbilling if they are inadvertently charged for services that were not properly billed to insurance providers. This can result in unexpected medical expenses and financial stress.
Insurance Hassles: Patients may face complications with their insurance claims, leading to disputes, appeals, and prolonged administrative processes. These challenges can add to the already stressful experience of dealing with a medical condition.
Underbilling and missed contrast coding in radiology have multifaceted implications, impacting both healthcare facilities and patients. These issues are not isolated administrative concerns but have downstream consequences that affect financial stability, operational efficiency, patient care, and even patient well-being. To mitigate these challenges effectively, healthcare facilities must take a good look at what advanced technology can do for them.
Enlitic’s ENDEX™ is empowering healthcare enterprises to harness high-quality data for meaningful impact. Embracing technology and data standardization is the way forward for healthcare organizations to trust their data. While the standardized study labels account for contrast, billing departments can work to ensure what is billed for is what was performed.
Learn other issues of non-standardized data and how we solve them for healthcare leadership, here.
1 Bresnahan BW, Rudin RS, Eisenberg JD. Failure to bill for contrast material: a nationwide survey of academic medical centers. J Am Coll Radiol. 2018 Feb;15(2):366-370. doi: 10.1016/j.jacr.2017.09.038. PMID: 29128340