Radiology Audits


Recently insurance carriers have been auditing radiology services. Some of the areas being audited you may not have even given thought to checking. For example, do the images include the initials of the technician who performed the service? Without this information, the carriers can deny the claim until the technician has been identified and their credentials verified indicting they have the required certification to perform the service.

Insurance carriers are also verifying the orders with the ordering provider to make sure the medical necessity for ordering the test is documented. In some cases, the insurance carrier is leaving that responsibility up to the servicing provider. 

The source document frequently referenced by the carriers is the DOH Medicaid Update May 2006 Vol.21, No 5, Documentation Requirements for Ordered Services. Check it out https://www.health.ny.gov/health_care/medicaid/program/update/2006/may2006.htm

These are just two of the audit areas currently under review.