Diagnostic imaging & radiology
Hospital-based, office-based, and mobile imaging, including reading groups that bill professional-only.
What we watch
Modifier 26 / TC assignment and duplicate global billing between the reader and the site.
DIAGNOSTICS & ANCILLARY
One template error, four hundred denials
Imaging, labs, therapy, sleep, DME, home health and hospice all share one trait: claim volume is high and payer tolerance for a documentation gap is close to zero. MBS bills this group with controls set at the batch level, so problems are caught as patterns.
Component splits
Technical, professional, and global billed to the right entity
Order & necessity
Referring order, signature, and diagnosis support on file
Coverage rules
LCD, NCD, and payer policy applied before submission
Volume controls
Batch-level edits so one template error is not repeated 400 times
A claim without a valid order is not submitted, it is returned to the referring source.
Frequency and coverage limits are checked before the service, not discovered in the remit.
Batch errors are reported as one root cause with a claim count, not as 400 separate denials.
WHAT WE BILL IN THIS GROUP
Six service lines, six different failure points
They are grouped together because the billing economics match. The rules that get claims paid do not.
Clinical & pathology labs
Reference and in-office labs where panel composition and payer edits decide payment.
What we watch
Panel unbundling edits and diagnosis codes that do not support the ordered test.
Physical, occupational & speech therapy
Time-based units, plan-of-care recertification, and therapy threshold documentation.
What we watch
Unit calculation against the eight-minute rule and expired plans of care.
Sleep medicine
In-lab studies and home sleep testing, with titration and follow-up billing.
What we watch
Home-versus-lab coverage criteria and prior-study frequency limits.
Durable medical equipment
Rental and purchase cycles, resupply schedules, and documentation-heavy coverage rules.
What we watch
Face-to-face documentation, proof of delivery, and rental month sequencing.
Home health & hospice
Episode and per-diem billing with election, certification, and eligibility requirements.
What we watch
Certification timing, overlapping episodes, and level-of-care changes mid-period.
What is in scope, and what is not
Written plainly so it can be forwarded internally without a call.
AreaIncludedNot included
Coding
CPT/HCPCS assignment, modifier application, diagnosis support review, and coder queries.
Writing or altering clinical reports. We ask; the interpreting provider decides.
Orders & documentation
Chasing missing orders, signatures, and certifications before submission.
Obtaining documentation on your behalf from a referring practice we have no relationship with.
Coverage rules
LCD/NCD and payer policy checks, frequency limits, and medical-necessity screening.
Guaranteeing coverage for a service the policy plainly excludes.
Claims & follow-up
Submission, rejection correction, denial appeals, and payment posting with reconciliation.
Patient collection agency work. We handle statements and inbound patient billing calls only.
Reporting
Volume, first-pass rate, denial reasons by referring source, and payer-level trends.
Blended single-score dashboards with no drill-down to the claims behind them.
See where your denial rate actually sits
High-volume providers often have a respectable average hiding a single payer or referring source doing most of the damage. The benchmark tool takes six figures and shows you the bands, with sources and verification dates attached.
Questions ancillary providers ask
We bill professional-only reads. Can you handle that?
Yes. Professional-only, technical-only, and global billing are treated as different workflows, and we reconcile against the site of service so the same study is not billed globally by two entities.
How do you deal with missing referring orders?
Claims without a valid, signed order are held and routed back to the referring source with what specifically is missing. Submitting them and appealing later is more expensive than fixing them up front.
Our denials come in waves. Does that get treated differently?
Yes — that is the defining feature of ancillary billing. A wave is usually one template, one payer policy change, or one order-form defect. We report it as a single root cause with the affected claim count, then fix it once.
Do you support DME rental cycles and resupply?
Yes, including rental month sequencing, proof-of-delivery requirements, and resupply timing rules that vary by payer.
Can you work in our existing system?
We work inside your practice management, RIS, or LIS rather than migrating you. Integration and interface access are confirmed during onboarding before a go-live date is agreed.
Where this group usually connects
Medical Coding
Certified coding and audit support where coverage rules and modifiers decide payment.
A/R Recovery
High-volume aged claims worked systematically, grouped by cause rather than one at a time.
Denial Management & Appeals
Medical-necessity and documentation denials appealed with the payer's own policy attached.
Looking for another specialty? See all specialties.
Give us one month of denials
We will group them by root cause, name the payers and referring sources driving them, and tell you which are preventable before the claim ever goes out.
How does your A/R and denial rate compare?
Free benchmark tool — enter six numbers, see your bands against published industry sources, and download a branded PDF.