The billing rules for outsourced final interpretations may appear complex, but vRad makes it easy. We’ve helped more than 900 clients successfully implement their final interpretations billing programs. Our clients are more confident about their compliance with federal billing requirements and can implement final interpretation services quickly with support from our payer enrollment team.
With vRad, you have three billing options for final interpretations: Payer Direct, Fee-for-Service + Medicare Payer Direct, or simply Fee-for-Service.
When you choose Payer Direct, vRad bills payers as payment for interpretations performed. Payer Direct saves you time and administration and reduces your reimbursement risk.
vRad works with you to evaluate your payer and modality mix to assess your eligibility including requirements to establish an electronic integration (HL7) between your systems and the vRad Imaging Platform. An HL7 integration ensures efficient delivery of patient demographic information required for billing.
The Payer Direct billing option requires approximately 90 days to complete. This time also is used to contract and enroll vRad radiologists with your third-party payers if we are not already enrolled.
You pay vRad a fee for all final interpretations other than those provided to Medicare enrollees. vRad bills those claims to the proper Medicare contractor, related secondary insurers, and the patient for the patient responsibility portion. This option saves you time and administration and reduces your reimbursement risk for Medicare enrollee claims.
You pay vRad a fee for all interpretations and you bill all guarantors per their requirements. If you elect the Feefor-Service option, to secure reimbursement according to CMS guidelines, you need to establish your own group practices in each MAC jurisdiction. Please consult your own healthcare counsel if you elect this option.
Private Commercial Insurance
vRad radiologists can be added to your existing contracts for most payers; you bill payers directly. vRad completes any necessary enrollment documents (fees apply) so you continue to process teleradiology-delivered final interpretation claims like any other claims.
vRad can assist with enrolling our radiologists into your Medicaid program (fees apply) and you bill Medicaid directly. Most states will allow you to enroll out-of-state providers and collect reimbursement with the exception of Georgia, Massachusetts, New York, Rhode Island and Texas.
Centers for Medicare & Medicaid Services (CMS) policy requires the professional component for interpretations be submitted directly to the Medicare Area Contractor (MAC) covering the area in which the radiologist performing the interpretation is located. This policy presents reimbursement challenges to final interpretation clients since they do not typically have relationships established with MACs outside their local area. This is why the Fee-for-Service with Medicare Payer Direct option offers the simplest and most cost-effective solution.
Contact us to learn more about how vRad’s final interpretation and billing solutions can help you make better decisions for the health of your patients and practice.