Revenue Cycle Management FAQs

Radiology Revenue Cycle Management

RCM in Radiology involves the entire process of managing patient information, scheduling, billing, and collecting payments for radiology services. It includes patient registration, insurance verification, coding, claims submission, payment posting, and patient follow-ups.

Effective RCM is crucial for radiology practices to ensure accurate and timely reimbursement for services rendered. It helps in minimizing denials, reducing claim errors, and improving cash flow, which is essential for the financial health of the practice.

The key components include:

  1. Patient Registration and Insurance Verification
  2. Medical Coding
  3. Charge Capture
  4. Claims Submission
  5. Payment Posting
  6. Denial Management
  7. Patient Billing and Collections

Radiology practices can improve RCM by:

  1. Ensuring accurate patient data and insurance information.
  2. Implementing efficient coding practices.
  3. Utilizing automated charge capture systems.
  4. Regularly monitoring claims for denials and rejections.
  5. Educating staff on best practices and compliance.

RCM in Radiology involves the entire process of managing patient information, scheduling, billing, and collecting payments for radiology services. It includes patient registration, insurance verification, coding, claims submission, payment posting, and patient follow-ups.

Effective RCM is crucial for radiology practices to ensure accurate and timely reimbursement for services rendered. It helps in minimizing denials, reducing claim errors, and improving cash flow, which is essential for the financial health of the practice.

The key components include:

  1. Patient Registration and Insurance Verification
  2. Medical Coding
  3. Charge Capture
  4. Claims Submission
  5. Payment Posting
  6. Denial Management
  7. Patient Billing and Collections

Radiology practices can improve RCM by:

  1. Ensuring accurate patient data and insurance information.
  2. Implementing efficient coding practices.
  3. Utilizing automated charge capture systems.
  4. Regularly monitoring claims for denials and rejections.
  5. Educating staff on best practices and compliance.

Medical coding in radiology involves translating radiology reports and procedures into standardized codes using ICD-10, CPT, and HCPCS codes. These codes are used for billing and insurance purposes.

Accurate coding ensures that radiology services are properly documented and reimbursed. It helps avoid claim denials, ensures compliance with regulations, and provides valuable data for practice analysis and improvement.

Common challenges include:

  1. Keeping up with frequent changes in coding guidelines.
  2. Ensuring documentation supports the codes billed.
  3. Handling complex cases with multiple procedures.
  4. Avoiding upcoding or undercoding, which can lead to compliance issues.

Practices can stay updated by:

  1. Subscribing to coding newsletters and updates.
  2. Attending coding seminars and webinars.
  3. Using coding software with regular updates.
  4. Hiring certified professional coders.

The billing process involves:

  1. Generating claims based on coded procedures.
  2. Submitting claims to insurance companies.
  3. Posting payments and handling adjustments.
  4. Following up on unpaid claims and denials.
  5. Sending statements to patients for their share of the costs.

To reduce errors, practices can:

  1. Ensure accurate patient and insurance information.
  2. Double-check codes before claims submission.
  3. Implement a robust charge capture process.
  4. Train staff regularly on billing practices.
  5. Utilize billing software to streamline processes.

Common reasons include:

  1. Incorrect or incomplete patient information.
  2. Missing or incorrect codes.
  3. Lack of medical necessity.
  4. Timely filing issues.
  5. Insurance coverage issues.

Handling denials involves:

  1. Analyzing the reason for denial.
  2. Correcting any errors in the claim.
  3. Resubmitting the corrected claim.
  4. Appealing the denial if necessary.
  5. Implementing measures to prevent future denials.

StreamlineMD provides comprehensive RCM services tailored to radiology practices. These services include patient registration, insurance verification, coding, billing, claims management, and collections. Our goal is to maximize reimbursement and streamline the financial processes of your practice.

Benefits include:

  1. Improved accuracy and efficiency in coding and billing.
  2. Faster claims processing and reduced denials.
  3. Enhanced cash flow and revenue.
  4. Compliance with regulations.

More time for clinical staff to focus on patient care.

To get started, radiology practices can contact StreamlineMD for a consultation. We will assess your current RCM processes and customize a solution that fits your practice’s needs. Our team will guide you through the implementation and provide ongoing support to ensure success.

Feel free to adjust these FAQs as needed to better match the specific services and features offered by StreamlineMD.

IR OBL Revenue Cycle Management

Office-Based Labs (OBLs) are outpatient settings where interventional radiologists can perform minimally invasive procedures. These labs provide a controlled environment, allowing for efficient, safe, and cost-effective patient care outside of a traditional hospital setting.

OBLs offer several benefits, including:

  1. Reduced patient costs compared to hospital settings.
  2. Greater convenience and comfort for patients.
  3. Increased control over scheduling and workflow.
  4. Enhanced patient satisfaction with personalized care.

RCM for Interventional Radiology involves managing the financial processes associated with patient care, from scheduling and insurance verification to billing and collections. It ensures accurate documentation, coding, and reimbursement for IR procedures.

Effective RCM is crucial to ensure that IR practices receive proper reimbursement for their services. It helps in minimizing claim denials, reducing errors, and maintaining a healthy cash flow, which is essential for the financial stability of the practice.

The key components include:

  1. Patient Registration and Insurance Verification
  2. Accurate Documentation and Coding
  3. Charge Capture and Claims Submission
  4. Payment Posting and Denial Management

Patient Billing and Collections

Practices can improve RCM by:

  1. Ensuring thorough patient data and insurance verification.
  2. Maintaining precise and comprehensive documentation.
  3. Utilizing automated systems for charge capture and claims submission.
  4. Regularly training staff on RCM best practices.
  5. Monitoring and analyzing RCM performance metrics.

Medical coding in Interventional Radiology involves translating the procedures performed into standardized codes using ICD-10, CPT, and HCPCS codes. These codes are essential for billing and insurance purposes.

Accurate coding ensures proper documentation and reimbursement for IR procedures. It helps avoid claim denials, ensures regulatory compliance, and provides valuable data for practice analysis and improvement.

Common challenges include:

  1. Keeping up with frequent changes in coding guidelines.
  2. Ensuring documentation supports the codes billed.
  3. Managing complex procedures with multiple components.
  4. Avoiding coding errors that can lead to denials or compliance issues.

Practices can stay updated by:

  1. Subscribing to coding newsletters and updates.
  2. Attending coding seminars and webinars.
  3. Using coding software with regular updates.
  4. Hiring certified professional coders with IR expertise.

The billing process involves:

  1. Generating claims based on coded IR procedures.
  2. Submitting claims to insurance companies.
  3. Posting payments and handling adjustments.
  4. Following up on unpaid claims and denials.
  5. Sending statements to patients for their share of the costs.

To reduce errors, practices can:

  1. Ensure accurate patient and insurance information.
  2. Double-check codes and documentation before claims submission.
  3. Implement a robust charge capture process.
  4. Regularly train staff on billing practices.
  5. Utilize billing software to streamline processes.

Common reasons include:

  1. Incorrect or incomplete patient information.
  2. Missing or incorrect codes.
  3. Lack of medical necessity documentation.
  4. Timely filing issues.
  5. Insurance coverage issues.

Handling denials involves:

  1. Analyzing the reason for denial.
  2. Correcting any errors in the claim.
  3. Resubmitting the corrected claim.
  4. Appealing the denial if necessary.
  5. Implementing measures to prevent future denials.

Operating an OBL requires compliance with various federal and state regulations, including facility licensing, radiation safety standards, and accreditation requirements. Practices must also adhere to guidelines set by organizations like the Centers for Medicare & Medicaid Services (CMS).

To ensure compliance, practices should:

  1. Stay updated on regulatory changes.
  2. Implement comprehensive policies and procedures.
  3. Conduct regular internal audits.
  4. Provide ongoing staff training.
  5. Engage with compliance consultants if needed.

Billing considerations for OBLs include understanding the specific reimbursement rates for office-based procedures, ensuring correct place-of-service coding, and managing any bundled payment models that apply to the outpatient setting.

OBLs can optimize financial performance by:

  1. Streamlining scheduling and patient flow.
  2. Maximizing charge capture and ensuring accurate coding.
  3. Regularly reviewing and negotiating payer contracts.
  4. Implementing efficient billing and collections processes.
  5. Monitoring financial metrics and making data-driven decisions.

StreamlineMD provides comprehensive RCM services tailored to Interventional Radiology practices and OBLs. These services include patient registration, insurance verification, coding, billing, claims management, and collections, all designed to maximize reimbursement and streamline financial processes.

Benefits include:

  1. Improved accuracy and efficiency in coding and billing.
  2. Faster claims processing and reduced denials.
  3. Enhanced cash flow and revenue.
  4. Compliance with regulatory requirements.
  5. More time for clinical staff to focus on patient care.

To get started, IR practices and OBLs can contact StreamlineMD for a consultation. We will assess your current RCM processes and customize a solution that fits your practice’s needs. Our team will guide you through the implementation and provide ongoing support to ensure success.

Are you ready to Streamline Your Practice?

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Notice

Cyber Incident Update – 9/28/25 at 6:00 pm EST:

StreamlineMD applications are up and live!

Access Client Portal Here

We are pleased to inform you that, following clearance from our cybersecurity experts, client access to our system has been restored. You may begin accessing the system starting at 6:00 PM EST today, Sunday, September 28, 2025.

Please note that while core functionality is fully restored, the following features are currently unavailable as we continue working to bring all components back online:

1. SMD Mobile App (viewing PDF chart)
2. Patient Portal
3. RxPhoto (inside the EHR)

We are working to restore these remaining services as quickly and securely as possible.

We will continue to monitor system performance closely and will provide updates as additional components become available.

If you experience any issues or require support, please contact our support team directly at 330-564-2641.

Thank you once again for your continued patience, understanding, and trust.

Cyber Incident Update – 9/28/25 at 2:00 pm EST:

Following our scheduled call with the cybersecurity team earlier today, we have been advised that additional security measures must be implemented before client access can be restored. Specifically, changes to our VPN configuration are required to ensure a more secure connection environment.

Our internal teams are actively working on these adjustments and will move as quickly and carefully as possible to complete the necessary changes.

Our next update will be at 4:00 PM EST.

Cyber Incident Update – 9/28/25 at 12:00 pm EST:

We are pleased to share that our internal teams currently have access to the system environment. In the interim, if needed, we are able to assist by running your patient appointment schedules for the week. Please contact our support team or email at smdhelpdesk@prcmedicalllc.zohosupport.com if you require this service.

We are scheduled to meet with our cybersecurity team at 1:00 PM EST today to review final clearance for restoring client access. We will provide another update following that discussion.

We appreciate your continued patience and partnership as we work to bring services back online safely and securely.

Cyber Incident Update – 9/27/25 at 10:00 pm EST:

We are pleased to report that our routine nightly processes have completed successfully, and the system environment remains stable and fully operational.

At this stage, we are awaiting final clearance from our cybersecurity partner before restoring client access.

However, our partner informed us that they need more time and so this clearance will not be available until after 1:00 PM EST tomorrow, Sunday, September 28, 2025.

Thank you for your patience while we maintain the highest standards of security and system integrity. 

Cyber Incident Update – 9/27/25 at 7:00 pm EST:

We are continuing to move forward with final preparations for restoring system access. Our internal teams have completed their validation processes, and the environment remains fully operational.

At this time, we are running our routine nightly processes to further confirm system stability and readiness. We continue to await final clearance from our cybersecurity experts to bring services fully back online.

We remain optimistic that systems will be accessible to clients by tomorrow morning, Sunday, September 29, 2025, at 7:00 AM EST.

As always, we are taking every measure to ensure a secure and controlled restoration.

Thank you again for your continued patience and support. Our next update will be provided by 10:00 PM EST.

Cyber Incident Update – 9/27/25 at 11:00 am EST:

We are pleased to share that our team has gained access to the system environment and is actively conducting testing—an important step toward the full restoration of services.

As part of this process, we have completed testing of the Practice Management (PM) and Coding software and are pleased to report that no issues have been identified with the software. Testing will continue across all system components to ensure overall stability and reliability.

Our teams will continue working throughout the day to validate all aspects of the system before bringing it back online.

We are deeply grateful for your continued patience, support, and trust as we proceed with restoration in a safe and controlled manner.

We will provide another update at 2:00 pm EST.

Cyber Incident Update – 9/26/25 at 7:00 pm EST:

We are pleased to share that our team is now gaining access to the system environment and actively conducting testing. This is an important step toward full restoration of services.

We again want to reassure you that there is no evidence of any compromise of Protected Health Information (PHI) or damage to our systems.

Our teams will continue to work throughout the evening and into the weekend to validate all aspects of the system before bringing it back online.

Thank you for your continued patience, support, and trust as we move forward with restoration in a safe and controlled manner.

We will provide another update at 10:00 am EST on Saturday, September 27, 2025.

Cyber Incident Update – 9/26/25 at 3:00 pm EST:

We continue to make steady progress in our restoration efforts. At this time, 95% of servers have been cleared; however, they remain behind protective firewalls as we work closely with our team of experts toward full restoration.

The StreamlineMD systems will remain unavailable for the rest of today, Friday, September 26, 2025. Our teams will begin comprehensive testing of all aspects of the system as soon as possible, likely this evening and over the weekend.

Importantly, there is no evidence of any compromise of Protected Health Information (PHI) or damage to our systems.

We truly appreciate your support and understanding during this process. You are important to us, and we remain committed to restoring services safely and securely.

We will provide another update at 6:00 pm EST.

Cyber Incident Update – 9/26/25 at 2:00 pm EST:

We continue to work diligently this afternoon with our cybersecurity team and are making steady progress.   

We anticipate the StreamlineMD systems will remain inaccessible for the remainder of today, Friday, September 26, 2025.  

We will provide another update at 6:00 pm EST.

We appreciate your continued patience and understanding as we work to restore services in a secure and controlled manner.

Cyber Incident Update – 9/26/25 at 11:00 am EST:

We continue to work throughout the day with our cybersecurity team and continue to make progress.  

We anticipate the StreamlineMD systems will not be accessible before 3:00 pm EST on Friday, September 26, 2025

We will provide another update at 2:00 pm EST.

We appreciate your continued patience and understanding as we work to restore services in a secure and controlled manner.

Cyber Incident Update – 9/26/25 at 09:00 am EST:

We continue to work this morning with our cybersecurity team and continue to make progress.   

We still don’t anticipate StreamlineMD systems to be fully operational before 12:00 pm EST on Friday, September 26, 2025.  

We will provide another update at 12:00 pm EST.

We appreciate your continued patience and understanding as we work to restore services in a secure and controlled manner.

Cyber Incident Update – 9/26/25 at 07:00 am EST:

We have continued to work through the night with our cybersecurity team and continue to make progress.  

We will continue restoring servers to service and testing internally. 

We still don’t anticipate StreamlineMD systems to be fully operational before 12:00 pm EST on Friday, September 26, 2025. 

We will provide another update at 9:00 am EST.

We appreciate your continued patience and understanding as we work to restore services in a secure and controlled manner.

Cyber Incident Update – 9/25/25 at 11:00 pm EST:

So far, we are making great progress, and our systems are internally coming back online. At this time, there is no evidence of system damage or PHI compromise.

Throughout the night, we will continue restoring servers to service and testing internally.

We don’t anticipate StreamlineMD systems to be fully operational before 12:00 pm EST on Friday, September 26, 2025.

We will provide another update on Friday, September 26, at 6:00 am EST


Cyber Incident Update –9/25/25 at 7:00 pm EST:

We are currently in the process of restoring our servers and anticipate determining a timeline for resuming full operations by 10:00 PM EST this evening, September 25, 2025.

Our team continues to work diligently and in close coordination with our security partners in response to the cybersecurity incident that occurred during the overnight hours of September 24, 2025. As a precaution, our systems remain offline to prevent any potential data compromise. We continue to follow our established cybersecurity protocols to ensure the protection and integrity of your data.

We will provide our next update by 10:00 PM EST today.

We appreciate your continued patience and understanding as we work to bring our systems back online safely.

Incident Update – 9/25/25 at 12:00 pm EST:

StreamlineMD is currently working closely with our security team to address a cybersecurity incident that occurred during the overnight hours of September 24, 2025. As a precautionary measure, we proactively shut down our systems to prevent any potential data compromise.

Our team is actively following established cybersecurity protocols to ensure the continued protection of your data. At this time, the software will remain inaccessible for the remainder of the day, September 25, 2025.

We understand the impact this may have on your operations and sincerely appreciate your patience and understanding. We are committed to providing updates as frequently as possible and will keep you informed of our progress.

StreamlineMD is experiencing a cyber incident

Our security software detected malicious behavior and our team of internal and external experts are working to resolve the issue. The security team has made it clear that we need to shut down our services altogether, pending a more detailed analysis.