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    The 5 biggest misconceptions about imaging coding and reimbursement

     

    If the insurance pays, the billing/coding was done properly 

    Most claims for images 2D, 3D or photographic are auto adjudicated. This means that if the claim for an image is submitted to a carrier and that claim meets the criterion established in the plan (subject to the established plan exclusions and limitations) it will be processed without review and paid with no other information needed. This can be wonderful if the claim is accurate but dangerous if the coding/billing is misunderstood and results in a payment that is not justified. It will be extremely important in the event of insurance audit or professional review that the doctor ordered the image based on medical necessity, that the doctor reviewed the image and that it was billed correctly. Otherwise, there could be a problem.

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    The bottom line

     The doctor is ultimately responsible for insuring that the billing/coding for that new technology, service or product is done correctly. The claim must be accurate and the information recorded in the clinical record must both establish and support the medical necessity for the service provided. Additionally, the information on the claim form must be accurate and the service provided described on the claim form using the current code that most accurately describes the service. Understand the misconceptions and you will maximize the legitimate reimbursement while reducing the risks associated with reimbursement any new technology, product or service.

    Dr. Roy Shelburne
    Dr. Shelburne, an honor graduate from VCU’s dental school, opened a private general practice in Pennington Gap, Va., in 1981. In 2008, ...

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