Every facility-based physician specialty faces specific challenges that make its revenue cycle management (RCM) unique. Radiology experiences nearly all of those challenges, plus a few more.
The physician shortage is hitting Radiology hard, with a shortfall of 42,000 radiologists expected by 2033. Several factors are converging to create the crisis, including a dramatic increase in the number of imaging studies needed, a decrease in the number of new radiologists entering the practice with the rise of AI, and a high percentage of current radiologists leaving the field due to retirement and/or burnout.
Those overworked radiologists manage extremely high volumes—increasing by up to 5% every year—with an extraordinarily complex CPT code set that covers every system in the body. These factors raise the risk of coding errors, which leads to reduced revenue in the form of denials, down-codes, and underpayments. With a high degree of repetition in Radiology cases, one provider documentation error could be repeated hundreds of times, resulting in thousands of dollars in missed revenue.
High procedural volumes and a large number of Medicare patients mean that Radiology is particularly affected by falling CMS reimbursement rates and government compliance programs such as the Merit-based Incentive Payment System (MIPS). Radiology RCM teams have to stay current on the strict and changing regulatory environment to ensure their clinicians remain compliant.
Additionally, most radiologists don’t interact directly with patients, so they depend on other physicians to provide much of the supporting clinical documentation they need to bill appropriately for their services. (An exception to this is the subspecialty of Interventional Radiology, in which the radiologist uses imaging techniques to perform procedures.)
With so many challenges potentially impacting revenue for Radiology groups, what can RCM teams do to improve Radiology billing processes and maximize reimbursement? The following strategies are a good place to start.
1. Specialized Coding Expertise
Even more than other physician specialties, Radiology requires dedicated expertise to master coding complexities and handle high-volume billing. Because the Radiology CPT code set covers all systems in the body, coders need a broader knowledge of anatomy, as well as a thorough understanding of the multiple vantage points from which those systems are imaged.
CPT code selection is also influenced by nuances such as patient status and views requested, making it extremely easy to miss a billable service or payment modifier. Coders, therefore, have to know what to look for within clinical documentation to bill to the appropriate level of specificity. Interventional Radiology takes the complexity up a notch even further, and coders who work in this area may need additional training on the highly specialized procedures of the vascular system.
2. Physician Education
Expert coders are a Radiology group’s best resource for improving Radiology revenue cycle management. Coding and compliance regulations change constantly—in fact, the 2025 CPT code set includes 26 new codes that impact Radiology and Interventional Radiology, plus 16 new codes for telemedicine. Specialized Radiology coding teams are monitoring the changes and can keep physicians up to date on issues that will impact revenue.
Working in partnership with physicians, coders can also uncover recurring documentation deficiencies that may result in down-codes and underpayments. Standardized documentation templates can have a big impact here, particularly in Radiology billing, where there is a lot of repetition. Expert coders can help physician groups build effective time-saving templates, identifying the key documentation data points that payers expect to see to support appropriate billing.
3. Optimized Patient Payments
With high-deductible plans and bigger co-pays, insurers continue to shift more of the payment burden to patients, which presents a significant challenge for Radiology revenue cycle management. According to a study published in the Journal of the American College of Radiology, overall out-of-pocket costs for imaging increased by nearly 90% between 2000 and 2019. Reduced reimbursement from payers has increased the pressure on Radiology RCM teams to collect patient portions.
An omnichannel strategy is the most effective approach to patient payments. In addition to traditional paper statements, successful practices are also leveraging email, online portals, texting, and other electronic methods to simplify the payment process for patients. When contacted through their preferred digital channels, nearly 50% of patients will pay their bills within an hour.
4. Purpose-Built Billing Systems
Medical billing technology designed for other specialties will lack critical features and functionalities to handle the complexities of Radiology billing. Practices can maximize reimbursement by ensuring their RCM teams use Radiology software solutions that are purpose-built for their workflows to improve coding accuracy, accelerate coding processes, and reduce denials.
5. Data & Analytics
Despite the obstacles to reimbursement, physician groups have a powerful tool to stay ahead of the curve—their data. By analyzing both benchmarking data and their own reimbursement data, practices can build effective strategies to improve profitability. A data-driven approach can proactively uncover and correct internal and external RCM issues that lead to claim denials, down-codes, and other payment delays. Automated alerts, for example, can identify an uptick in denials caused by a coding error that can be easily corrected before it results in significant revenue loss. Data can also be leveraged to improve partnerships with contracted hospitals, including negotiating reasonable stipends.
How Ventra Can Help
ADVOCATE RCM combined forces with Ventra Health in 2024 and is now known as the Ventra Health Radiology business unit. For more than 25 years, the Ventra Health Radiology team has focused exclusively on the complexities of Radiology RCM, honing the most sophisticated claims processing infrastructure available today. For every part of the revenue cycle, we have a custom-built process to identify and address revenue gaps. As a result, we deliver the lowest denial rates in the country.
Our team members are not only experts on the intricacies of Radiology billing and compliance but also industry advocates and recognized leaders in organizations such as the Radiology Business Management Association (RBMA). Working as an extension of your practice, they partner with you to improve coding accuracy, improve physician documentation, reduce audit challenges, and uncover issues that are negatively impacting your revenue. We also collected more than $1 million in increased patient payments last year using our omnichannel approach.
To deliver higher coding accuracy and actionable revenue insights, our experts leverage our proprietary billing software, along with AIMS, our powerful data & analytics platform. We also created a Performance Surveillance Team to focus solely on daily monitoring of more than 200 audit controls, watching for issues that may impact performance and working cross-departmentally to address them proactively.
As Radiology’s confluence of challenges persists, it only gets harder for practices to remain profitable and sustainable. A specialized, data-driven approach to Radiology revenue cycle management will help ensure practices are paid appropriately for the services they provide.
