Imaging & radiology billing
Billing Built Around the Imaging Journey
Imaging billing may involve order information, eligibility, authorization, service documentation, interpretation, coding, professional and technical billing considerations, payer rules and follow-up. Kitronixe helps organize those billing workflows from order through claim resolution.
- Orders ready38
- Authorization review12
- Service completed31
- Interpretation available27
- Coding review9
- Claims ready44
- Records requested4
Outstanding A/R$186.2K
Illustrative data for a fictional imaging provider. Not a Kitronixe result or a client’s figures.
The study, then the claim
An imaging claim follows the study - and everyone who touched it
An imaging claim follows the study: an order, often an authorization, the service itself, an interpretation, and documentation from more than one party. How the claim is built can depend on who performed which part of the service.
Kitronixe organizes the billing workflow around that journey - checking what each claim needs, coordinating component considerations based on the actual arrangement and documentation, and following payer responses through. Imaging services and interpretation remain with the provider.
- 01Order
- 02Authorization
- 03Study performed
- 04Interpretation
- 05Components considered
- 06Claim
Order to payment
The imaging journey, from order to payment
- Imaging Order
- Eligibility
- Authorization Review
- Service Scheduled
- Imaging Performed
- Interpretation / Documentation
- Coding Review
- Claim Validation
- Submission
- Payment / Follow-Up
Stage 1 of 10
Imaging Order
The study is ordered; its details travel with the claim.
01 Imaging Order
The study is ordered; its details travel with the claim.
02 Eligibility
Coverage confirmed for the service.
03 Authorization Review
Whether authorization applies is checked, depending on payer and service.
04 Service Scheduled
The study is scheduled.
05 Imaging Performed
The technical service is performed.
06 Interpretation / Documentation
The interpretation and documentation are completed by the provider.
07 Coding Review
Coding reviewed based on documentation and the service performed.
08 Claim Validation
Component, modifier and payer considerations checked where applicable.
09 Submission
The claim is submitted and tracked.
10 Payment / Follow-Up
Payment posted, or the claim followed up to a close.
Imaging modality map
Each modality brings its own billing considerations
Billing considerations
MRI
- Authorization
- Frequently subject to authorization, depending on payer and study.
- Documentation
- Sequences, contrast and body area documented as performed.
- Service setting
- Ownership and setting affect component billing.
- Payer requirements
- Payer policies vary; authorization is checked against the service.
Where applicable to the services you perform. No procedure-specific reimbursement is implied.
Professional, technical, global
One imaging service, up to two billable portions
Imaging service
What it represents
Technical component
The equipment and technical side of performing the service - where it applies.
Modifier considerations
Modifier TC considerations may apply where only the technical portion is billed.
When it may apply
When one party performs the technical service and another provides the interpretation - depending on the arrangement and payer.
Educational, not coding advice. There is no single rule - actual billing depends on:
- The service arrangement
- The place of service
- Ownership and contractual arrangements
- Payer rules
- The documentation
- Who performed which portion of the service
Authorization to claim
The authorization is checked twice: before the study and after it
1
Authorization requirement identified
Whether the payer requires authorization for this service is established before scheduling.
2
Request / reference available
The authorization request is made, and its reference recorded where one is issued.
3
Service scheduled
The study is scheduled within the authorization’s terms, where they apply.
4
Service performed
The imaging service is performed and documented.
5
Authorization details checked against service
What was performed is compared with what was authorized before billing.
6
Claim prepared
The claim is built with the authorization details it needs.
7
Payer processed
The payer adjudicates the claim.
8
Follow-up if required
A denial or request is worked; authorization issues go back through the authorization workflow.
Authorization requirements vary by payer and service, and an authorization does not guarantee payment. See Prior Authorization
The work queue
Every open study, with its issue and next action
Imaging billing work queue
Filter by modality
| Study | Modality | Issue | Payer | Age | Next action |
|---|---|---|---|---|---|
| Study 01 | MRI | Authorization issue | Payer B | 6 days | Authorization workflow |
| Study 02 | CT | Missing order | Payer A | 3 days | Request order details |
| Study 03 | Ultrasound | Documentation review | Payer C | 4 days | Review against the report |
| Study 04 | X-Ray | Interpretation pending | Payer A | 2 days | Wait for the report |
| Study 05 | MRI | Coding review | Payer D | 5 days | Coding coordination |
| Study 06 | CT | Modifier review | Payer B | 3 days | Check component arrangement |
| Study 07 | Mammography | Claim edit | Payer C | 7 days | Correct before submission |
| Study 08 | Ultrasound | Rejected | Payer D | 11 days | Correct and resubmit |
| Study 09 | Nuclear medicine | Denied | Payer A | 41 days | Denial workflow |
| Study 10 | CT | Records requested | Payer B | 29 days | Send records and report |
| Study 11 | X-Ray | Outstanding A/R | Payer C | 66 days | Claim-status follow-up |
Study 01MRI
Authorization issue
Payer B · 6 days
Authorization workflow
Study 02CT
Missing order
Payer A · 3 days
Request order details
Study 03Ultrasound
Documentation review
Payer C · 4 days
Review against the report
Study 04X-Ray
Interpretation pending
Payer A · 2 days
Wait for the report
Study 05MRI
Coding review
Payer D · 5 days
Coding coordination
Study 06CT
Modifier review
Payer B · 3 days
Check component arrangement
Study 07Mammography
Claim edit
Payer C · 7 days
Correct before submission
Study 08Ultrasound
Rejected
Payer D · 11 days
Correct and resubmit
Study 09Nuclear medicine
Denied
Payer A · 41 days
Denial workflow
Study 10CT
Records requested
Payer B · 29 days
Send records and report
Study 11X-Ray
Outstanding A/R
Payer C · 66 days
Claim-status follow-up
11 studies shown
Illustrative work queue: invented studies, identified by number, with payers shown as letters. No patient information; not a Kitronixe result.
What is covered
Imaging billing capabilities, depending on the scope you choose
Before the study
Eligibility workflow
Coverage verified for the service where payer systems allow.
Authorization workflow support
Authorization requirements checked and coordinated, depending on payer and service.
Order information
Order details reviewed for what the claim requires.
Service documentation
Service records matched to what is being billed.
Documentation, coding & components
Interpretation documentation workflow
Interpretations tracked so a missing report does not hold the claim.
Coding coordination
Coding coordinated based on documentation and the service performed.
Professional / technical billing considerations
Component billing reviewed based on who performed which part of the service, the setting and the payer.
Modifier review where applicable
Modifiers reviewed where the service, arrangement and payer call for them.
Claim validation
Claims checked against payer requirements before submission.
Claim submission
Claims submitted electronically where the payer accepts them.
Payer response
Rejections
Rejections corrected and resubmitted.
Denials
Denials worked by cause, with the pattern reported back.
Records requests
Payer requests for records tracked, answered and followed.
Payment posting
Payments and adjustments posted accurately.
Payments, A/R & reporting
Reconciliation
Remittances reconciled against what was billed.
A/R
Open imaging claims worked by priority.
Payer follow-up
Claims followed up with payers, with each action recorded.
Reporting
Claims, authorization issues, edits, denials and A/R, reported regularly.
Reporting
Reported by modality, payer and location
- Claims by modality
- Authorization issues
- Claim edits
- Denials
- Records requests
- Payments
- Outstanding A/R
- A/R by payer
- A/R by location
- Outstanding work
- Built only from what your billing data carries - modality and location breakdowns where that information exists.
Where this sits
Imaging Billing, Physician Billing and Prior Authorization
Imaging & Radiology BillingThis page
The billing workflow around the study - order to claim, including component considerations.
Physician Billing
Professional-fee billing for providers, including interpreting physicians where scoped.
Prior Authorization
The dedicated service for securing authorizations before the service.
Why Kitronixe
How Kitronixe works imaging claims
Built around the study
Billing follows the imaging journey, from order to interpretation to claim.
Authorization checked twice
Before the service, and again against what was actually performed.
Components reviewed, not assumed
Technical, professional and global billing depend on the actual arrangement, and are reviewed as such.
Missing reports caught
A claim waiting on an interpretation is visible, not silently held.
Modality-level visibility
Where the data allows, claims and A/R reported by modality and location.
Scope that fits
Engage full imaging billing, or the parts your team does not cover.
What does imaging billing support include?
Billing workflow support: orders, eligibility, authorization coordination, documentation and interpretation workflow, coding coordination, component and modifier considerations, claims, rejections, denials, records requests, posting, A/R and reporting - depending on the agreed scope. Kitronixe does not perform imaging or interpret studies.
Can you help with radiology billing?
Yes. Radiology billing workflows are supported the same way - built around the study, its authorization, its interpretation and its documentation.
Can you help with imaging authorization workflows?
Yes. Authorization requirements are checked before the service and again against what was performed. Requirements vary by payer and service; for a dedicated authorization service, see Prior Authorization.
Do you support professional and technical billing workflows?
Yes, where they apply. How an imaging service is billed depends on who performed which part of it, the setting, ownership and contractual arrangements, the payer and the documentation.
What are professional and technical components?
Broadly, the technical component is the equipment and technical side of performing the service, and the professional component is the physician’s interpretation. Whether a service is billed by component or globally depends on the actual circumstances and payer rules - there is no single rule for every case.
Can you help with modifier review?
Yes. Modifiers such as those used for technical or professional components are reviewed where applicable, based on the arrangement, documentation and payer requirements.
Can you work denied imaging claims?
Yes. Denials are worked by cause - including authorization-related denials - and corrected, appealed where appropriate, or closed with a reason.
Can you handle medical-record requests?
Yes. Requests are tracked, the documentation and reports are gathered and sent, and the claim is followed until the payer responds.
Can you work imaging A/R?
Yes. Open imaging claims are prioritized by status, payer response, filing limits, balance and age. No outcome can be guaranteed.
Can you provide modality-level reporting?
Where the billing data carries modality or service information, reporting can be broken down by modality, alongside payer, location and age.
Talk through your imaging billing
Tell us how studies move from order to claim today. We will say plainly where the workflow could be tightened.