A Radiology Billing Case Study

It’s extremely easy for a radiology group to lose control of its billing operations. There are a few management and personnel circumstances which can prompt this to happen…

  1. The primary administrative person is overwhelmed, incompetent, uninformed on proper billing controls, or simply too trusting of those in charge of billing—any of these shortfalls can lead to a total loss of control.
  2. The group of radiologists are hands off, completely uninvolved in billing, not armed with the knowledge (or interest) to know how to inspect it correctly.
  3. The billing staff is not properly equipped or knowledgeable enough to thoroughly accomplish their job. This involves everything from being overwhelmed to incompetent to dishonest. An understaffed department will eventually fail as well.  

If any one (or all three) of these instances are occurring in your office, the wheels will come off fast.

Fortunately, Dexios’ on-site, long-term and surprisingly affordable consulting and supplemental services can help put things back together again. We’re so confident in our ability to improve your practice’s billing performance, we’ve won national awards for it. Read on for a true story of one such instance.

Unique Challenges—Personnel + Management

We were called into a practice by radiologists because they suspected something was wrong. They had a veteran practice manager who had been with them since back when they were a small practice. The practice manager had very little interest in being involved in billing. Fast forward, and the group has grown to 30+ radiologists who were completely uninvolved, and assumed the practice manager had billing operations covered. They didn’t have the right group of trained and motivated people to execute in-house billing, not to mention they had no coding specialists or certified coders. All coding was being performed by billing specialists.

To add to the difficulty here, the practice manager was running a one-man in-house billing operation. Right out the gate, we identified that all three of the scenarios discussed above were occurring.

Audit + Analysis

These big personnel and management inefficiencies were followed by a host of bad habits taking the entire billing system to the point where most of the data was inaccurate and unreliable. AR was carelessly managed—no rhyme or reason to data entry as well as random, massive write-offs. We discovered their billing software was setup to calculate write-offs as contractual adjustments to mask the large sums of money being lost. Other mistakes and inefficiencies included…

    • Posting payments without balancing
    • Posting takebacks or only posting partial vouchers
    • Months of paper checks stuffed in drawers
    • Approximately 6 months of backlogged charges
    • All payments, with the exception of electronic Medicare transactions, were coming in on paper
    • Hospital data feeds were imported on paper, requiring manual entry
    • Billing staff failed to follow up or work on denials
    • Absence of filing and document scanning methods meant no record collections
    • Days in AR was close to 100
  • Incorrect refunds with balances rising above the mid-six figures

Solutions + Recommendations

Due to the magnitude of problems with the practice’s personnel and management, our first recommendation was to immediately begin outsourcing billing processes. This suggestion was met with resistance mostly in part because the practice still lacked an understanding of the depth and severity of their billing problems. Consequently, we tried to hire good managers who understood the existing billing software.

Our biggest recommendation was to create a new instance of the billing software so that it was set up correctly. Again, this idea was denied, so we were tasked with turning around the entire billing system without approval to start fresh with an outsourced billing system or new billing software.

With the core recommendations denied, most billing companies would throw their hands in the air and assume they’d come to the end of the road. At Dexios, we work with what we’re given. In the next 6 months, we spent countless hours and sleepless nights to get our client’s billing system closer to normal.


Within those initial 6 months, we successfully changed the settings in their current billing system to comply with RBMA standards of accounting and classification. This meant that that the new data was 100% usable and accurate—a seismic shift for the practice. What followed were a group of small, yet impactful steps to eliminate inefficiencies…

    • Scanning and appropriately filing all supporting documentation
    • Balancing payments before electronically posting
    • Evaluating refunds prior to processing
    • Updating charges and payments to current status including hospitals brought in while the billing system was in disarray
  • Shifting coding work to certified coders and implementing PQRS

For about a year and a half, Dexios was on-site in a consulting capacity. Now, the group had one major element you’d expect from a practice—records collections. Additionally, the Net Collection Percentage for all tax IDs averaged well over 100% as the old AR was worked down. Credit balances were reduced by half as the entire refund process was revamped.

To hear more success stories of radiology billing departments reinvented contact Dexios today.

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