Evaluating Billing Companies for Radiology
Radiology billing outsourcing requires a company that understands the component billing model, can handle multi-facility claim routing, and has experience with radiology benefit management (RBM) authorization workflows. A billing company that excels at primary care or surgical billing will struggle with the modifier 26/TC/global distinctions, the volume of codes with similar-sounding but clinically different descriptions, and the multi-site complexity common in radiology groups.
Criteria 1: Component Billing Expertise
The billing company must demonstrate thorough understanding of professional (modifier 26), technical (modifier TC), and global billing. Ask them to explain when each is appropriate and how they handle radiologists who read studies from facilities with different billing arrangements. A common scenario: the same radiologist reads CT scans from Hospital A (bill 26 only) and MRI scans from the group freestanding center (bill global). The billing system must route these claims correctly without manual intervention.
Criteria 2: Multi-Site and Multi-Entity Management
Radiology groups covering multiple hospitals, imaging centers, and outpatient facilities generate separate claim streams for each location. The billing company must manage distinct facility NPIs, different payer contracts per facility, facility-specific fee schedules, and place-of-service coding. Ask about their experience with multi-site groups and how many facility locations they can support per client.
Criteria 3: RBM and Authorization Handling
If the radiology practice or imaging center is responsible for obtaining imaging authorization (rather than the ordering physician office), the billing company should track authorization status for every scheduled advanced imaging study. Ask about their process for flagging studies scheduled without confirmed authorization and their workflow for emergency/stat studies that bypass the normal authorization process.
Criteria 4: Volume Processing
Radiology generates high claim volumes relative to practice size. A 5-radiologist group may generate 2,000 to 3,000 professional claims per month. An imaging center adds another 1,000 to 2,000 technical or global claims. The billing company must process this volume with same-day or next-day submission timelines. Ask about their claims-per-biller capacity and whether they assign dedicated staff to radiology clients.
Criteria 5: Pricing
Radiology billing outsourcing pricing ranges from 4% to 7% of collections, generally lower than other specialties because of the higher volume and more predictable coding patterns. Per-claim pricing ($3 to $6 per claim) works well for high-volume groups. Some companies price differently for professional-only claims (lower fee) versus global claims (higher fee) to reflect the revenue difference.
Integration Requirements
The billing company should integrate with the RIS (Radiology Information System) and PACS workflow. Ideally, study completion in the RIS automatically triggers charge capture, and report signing triggers the billing event. Manual charge entry for radiology at the volumes most groups process is error-prone and creates submission delays.