SpecialtiesDiagnostics & laboratory
How we see radiology billing.
Reviewed by the VisMed diagnostics & laboratory billing team
A radiology claim rests on an order from a referring physician, on the diagnosis that order carries, and on who owns the equipment and who reads the image. The technical component belongs to the owner of the machine, the professional component to the reader, and the global to whoever does both. Get the split wrong and the claim is denied or the practice bills for something it did not provide.
Medical necessity is enforced through the diagnosis on the order. Local coverage determinations list which diagnoses support which studies, and a study performed on an order that does not meet them is denied after the fact. Authorization is required on most advanced imaging, and the practice performing the study bears the loss if the referrer did not obtain it.
VisMed checks every order before the study is performed, holds a component and supervision rule set per site and payer, reconciles the read log to claims, and sends the referring offices that generate denials a short monthly note on what to fix.
Where radiology practices lose money
The patterns we find in the aging and denial history before anything else changes.
Studies performed without valid authorization
The referring office says it was obtained; it was not, or it was for a different study. The imaging practice performs the scan and eats the denial.Diagnosis on the order fails coverage edits
A study ordered with a diagnosis outside the coverage determination is denied on medical necessity, and the notice requirements for billing the patient were not met.Component billing errors
Global billed when only the professional component was provided, or the wrong modifier for the site, produces denials and compliance exposure.Contrast, add-ons and multiple procedures
Contrast material, additional views, three-dimensional reconstruction and multiple-procedure reductions are frequently missed or applied wrong.Supervision and IDTF enrollment
Technical components need the right supervision level and, for independent facilities, an enrollment and accreditation trail. Gaps make every technical claim vulnerable.
What we do differently for radiology
Specialty-matched coders and a denials specialist, working inside your own system.
We verify the order before the study
We confirm the authorization against the study actually scheduled and check the diagnosis against coverage edits, and we contact the referrer before the appointment when either fails.We set component rules by site and payer
Ownership, reading arrangements and supervision are mapped at onboarding, so each study bills global or split correctly for its site.We reconcile the read log
Every study on the modality worklist is matched to a claim with its contrast, add-ons and modifiers.We give referrers feedback
Ordering offices that repeatedly send incomplete orders or missing authorizations get a short report from us, so the problem is fixed at the source.
What we bill
The procedure and code families your account team already works in.
Radiology billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
The referring office was supposed to get the authorization. Why is it our problem?
Because the payer denies the performing practice’s claim, not the referrer’s. VisMed verifies every authorization against the scheduled study before it is performed, and goes back to the referrer when it is missing or does not match, so the study is not done at your expense.
How does VisMed handle medical-necessity edits?
VisMed checks the diagnosis on the order against the payer’s coverage rules for that study before the appointment. Where it fails, we ask the referrer for clarification or give the patient the required notice before the study.
We read for several facilities. Can VisMed bill the professional components?
VisMed maps each facility arrangement so the professional component is billed with the right modifier and place of service, and reconciles the reading log to claims per site.
Does VisMed handle IDTF enrollment?
VisMed’s credentialing team handles enrollment, supervising-physician designations, accreditation documentation and the changes that have to be reported.
Does VisMed bill teleradiology reads across state lines?
Each state where the patient is located needs the reading physician licensed and enrolled, and the place of service follows the patient. VisMed tracks licensure and enrollment per radiologist per state and builds the claim accordingly.
Also in diagnostics & laboratory
Pathology
Specimen-level coding and reference-lab billing.
Clinical laboratory
Panels, medical necessity and LCD edits.
Molecular & genetic testing
Z-codes, prior auth and payer policy tracking.
Toxicology
Presumptive vs definitive, units and frequency limits.
Independent diagnostic testing facilities
Supervision, enrollment and technical claims.
All specialties
The full list, in six groups
See where your radiology practice is losing money. Free.
Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
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