Medwave delivers specialized medical billing, credentialing, and payer contracting services to radiology practices, imaging centers, and diagnostic facilities nationwide.
Radiology has become essential to modern healthcare delivery. From routine X-rays to advanced MRI and CT scans, imaging services help physicians diagnose conditions accurately and monitor treatment progress. The field continues to advance with innovations like 3D mammography, interventional radiology procedures, and AI-assisted image analysis.
Imaging centers operate in various settings. Some function as independent diagnostic facilities, while others exist within hospital systems or multi-specialty practices. Mobile imaging services bring diagnostic capabilities to underserved areas. Teleradiology allows radiologists to read images remotely, expanding access to specialized interpretation across geographic boundaries.
The business side of radiology presents distinct challenges. Technical and professional components require separate billing. Prior authorizations delay studies and create administrative bottlenecks. Multiple reading radiologists need proper credential management. Equipment costs run high, making revenue cycle efficiency critical to financial sustainability.
Coding in radiology involves constant updates as new imaging techniques emerge and existing codes get revised. Contrast administration, 3D reconstruction, and computer-aided detection all carry specific billing requirements. Medicare’s Multiple Procedure Payment Reduction (MPPR) affects reimbursement when multiple imaging studies occur during the same session.
We help radiology providers manage the financial and administrative operations that support quality diagnostic imaging services.
Radiology Medical Billing
Radiology billing requires technical precision and deep knowledge of imaging-specific regulations. Every study involves multiple billing components, each with its own coding requirements and reimbursement rules. Our team handles this intricacy so you can focus on accurate diagnoses.
Our radiology-focused billing services include:
- Component Billing Expertise – We correctly separate and bill technical components (TC) and professional components (PC) based on your practice structure. Whether you own the equipment or provide interpretation services only, we ensure proper component billing that maximizes legitimate reimbursement.
- Modifier Management – Radiology relies heavily on modifiers to describe bilateral studies, multiple procedures, professional components, and technical components. Incorrect modifier usage leads to denials or underpayment. We apply modifiers accurately on every claim, following payer-specific requirements that vary across different insurance companies.
- Prior Authorization Handling – Advanced imaging often requires prior authorization before services can be rendered. We manage this process proactively, obtaining authorizations before scheduled appointments to prevent cancellations and ensure payment. When authorizations are denied, we work with ordering physicians to provide supporting documentation for appeals.
- MPPR Calculations – Medicare’s Multiple Procedure Payment Reduction applies when multiple imaging studies occur during the same session. We calculate these reductions correctly, ensuring claims are submitted with accurate expected reimbursement and reducing back-and-forth with payers over payment amounts.
- Contrast and Supply Billing – Contrast agents and other supplies used during imaging procedures require separate billing. We track supply usage, apply appropriate codes, and ensure these items are reimbursed separately from the imaging procedure itself.
- Denial Management – Radiology claims face denials for various reasons: medical necessity disputes, missing documentation, incorrect modifiers, or bundling issues. We appeal denials aggressively, providing the documentation and arguments needed to overturn incorrect payment decisions.
- Equipment Optimization – Our reporting shows utilization rates by equipment type and modality, helping you identify underused machines and high-revenue procedures. This data supports decisions about equipment purchases, scheduling optimization, and service line expansion.
Radiology reimbursement has faced downward pressure for years. Practices need every legitimate dollar to offset equipment costs, maintenance expenses, and staffing requirements. We protect your revenue through accurate coding, persistent follow-up, and strategic appeals.
Radiology Credentialing
Radiologist credentialing involves specific requirements beyond standard physician credentialing. Board certification in radiology or a relevant subspecialty forms the foundation. Additional certifications for fluoroscopy, mammography, and other specialized procedures require separate documentation.
What we manage in your credentialing process:
We gather all necessary documentation including medical licenses, board certifications (ABR or AOA), DEA registration, malpractice insurance, and facility accreditations. For mammography providers, we ensure MQSA (Mammography Quality Standards Act) certifications are current and properly documented.
Radiologists often work with multiple facilities through teleradiology arrangements. Each facility relationship requires separate credentialing with various hospital systems and imaging centers. We manage these multiple credentialing processes simultaneously, tracking deadlines and requirements across different organizations.
Credentialing benefits for radiology practices:
- Subspecialty certifications are documented and highlighted appropriately
- MQSA and other specialized procedure certifications are tracked separately
- Hospital medical staff credentials are coordinated with insurance credentialing
- Teleradiology arrangements are supported with proper documentation
- State-specific licensing for multi-state practices is monitored continuously
Many radiologists maintain privileges at multiple hospitals while also working with outpatient imaging centers. This creates overlapping credentialing requirements that must be coordinated carefully. We ensure nothing lapses, preventing gaps that could disrupt reading assignments or payment.
ACR (American College of Radiology) accreditation for imaging facilities adds another layer to credentialing requirements. We help document facility accreditations alongside individual provider credentials, presenting complete packages to payers and hospitals.
Radiology Contracting
Imaging reimbursement varies dramatically between payers and contract types. Some insurance companies reimburse technical components generously while paying professional fees poorly. Others bundle services in ways that reduce total payment. Understanding these differences helps negotiate better agreements.
Our payer contracting specialists analyze your current radiology contracts with focus on modality-specific reimbursement. We examine rates for X-rays, CT scans, MRIs, ultrasounds, nuclear medicine, and interventional procedures. Each modality has different cost structures and revenue potential.
Then we negotiate improvements based on your practice’s service mix and market position. This might include better rates for high-cost modalities like MRI and CT, improved bundling terms that recognize the true cost of providing services, or clearer language around authorization requirements that currently create administrative burden.
Key contracting considerations for radiology:
- Equipment costs differ dramatically between modalities. A basic X-ray machine costs far less than an MRI scanner. Contracts should reflect these cost differences through appropriate reimbursement rates that allow practices to recoup equipment investments while maintaining reasonable margins.
- Technical component reimbursement must cover equipment costs, maintenance, supplies, technologist salaries, and facility overhead. Professional component fees need to support radiologist reading time and expertise. We negotiate rates that recognize both components’ distinct cost structures.
- Many contracts include language about “incident to” billing, teleradiology reading fees, and after-hours interpretation charges. These provisions significantly impact revenue but often receive insufficient attention during initial negotiations. We review these details carefully and negotiate terms that protect your financial interests.
- Some payers reimburse based on the Medicare Physician Fee Schedule, while others use percentage-of-charges or flat fee schedules. We analyze which payment methodology works best for your specific service mix and negotiate accordingly.
- Prior authorization requirements create administrative costs that reduce profitability. We negotiate to streamline authorization processes where possible, or ensure reimbursement rates compensate for the administrative burden these requirements create.
- The shift toward value-based care and bundled payments affects radiology differently than other specialties. We help you prepare for these payment models while ensuring current fee-for-service contracts remain strong during the transition period.
Summary: Credentialing for Radiology Services
Medwave provides billing, credentialing, and contracting services designed specifically for radiology practices, imaging centers, hospital radiology departments, and teleradiology groups nationwide. Whether you operate a single-modality facility or a full-service diagnostic imaging center, we understand the unique financial challenges you face. Our team manages the technical aspects of radiology billing, including proper component separation, modifier application, prior authorization handling, and MPPR calculations. We credential radiologists with board certifications and subspecialty qualifications across multiple facilities and hospital systems, tracking MQSA certifications and ACR accreditations. Our payer contracting specialists negotiate modality-specific reimbursement rates that reflect equipment costs and service complexity, from basic X-rays to advanced MRI and interventional procedures. We help radiology providers optimize revenue cycles while focusing on accurate diagnostic imaging services.
Contact us today to learn how we can strengthen your practice’s revenue cycle and support your mission of providing accurate, timely diagnostic services.