Radiology Claims Audit
Component billing, modality coding, and authorization reviewed across diagnostic and interventional imaging.
In 2026, radiology billing is under greater scrutiny by payers than ever before, driven by sophisticated utilization management (UM) strategies for imaging, AI-driven prior authorization initiatives, shifting medical necessity guidelines, and growing value-based payment models. Coding/moderator and documentation mistakes—even minor ones—can lead to denials, delayed payments, compliance issues and lost revenue.
ZechionMed's Radiology Claims Audit solution helps imaging centers, hospital radiology departments, physician groups, teleradiology services, and interventional radiology practices reduce claim inaccuracy, collect reimbursements that they are entitled to, and enhance compliance with payers.
What We Cover
Medical Necessity Validation · Verification Against
CT and MRI Billing Audit · Validation of
- Compare the contrast studies to non-contrast studies.
- Multiple imaging session billing
- Correct CPT selection
- Appropriate utilization documentation
- Medical necessity support
Ultrasound Claims Review · Audit of
- Diagnostic ultrasound coding
- Vascular ultrasound procedures
- Obstetric ultrasound billing
- Duplex imaging claims
- Documentation requirements
Nuclear Medicine Audit · Review of
- PET and SPECT studies
- Radiopharmaceutical billing
- Nuclear cardiology imaging
- Correct HCPCS utilization
- Medical necessity compliance
Interventional Radiology Claims Audit
Validation of
- Image-guided procedures
- Catheter placement coding
- Embolization procedures
- Vascular interventions
- The need to bundle and unbundle compliance.
- An assessment of the skills and knowledge gained in the Professional vs Technical component.
Professional vs Technical Component Review
Properly split billing between:
- Professional interpretation services
- Technical imaging services
- Global billing scenarios
- Shared service arrangements
- Ownership of hospital and physicians in hospital.
Modifier 26 and TC Analysis · Detailed Review of
- Modifier 26 Professional Component
- Modifier TC Technical Component
- Global billing errors
- Duplicate reimbursement risks
- Split billing compliance
Medical Necessity Validation · Verification Against
- Medicare LCD/NCD requirements
- Commercial payers imaging policies
- Appropriate diagnosis support
- Prior authorization compliance
- Frequency limitations
What We Cover
Documentation Matching
Correct CPT Assignment
Our specialists validate:
- Imaging procedure selection
- Contrast administration coding
- Multi-study billing accuracy
- Add-on code utilization
- Interventional procedure coding
Payer Policy Compliance
We assess for compliance with:
- Medicare imaging policies
- Commercial payer edits
- NCCI guidelines
- Prior authorization rules
- Site-of-service requirements
Documentation Matching
Our auditors ensure:
- Physician orders are a valid way to bill for services.
- Radiology reports are an important aid in coding.
- Medical Records Provide Proof of Medical Necessity
- The procedures are documented to correspond with the claims.
- Findings are helpful in selecting the diagnosis.
What We Cover
Imaging Revenue Integrity Analysis
Advanced Imaging Utilization Compliance
Review of Utilization Management Requirements for
- CT scans
- MRI studies
- PET imaging
- Nuclear medicine procedures
Site-of-Service Optimization Review
Assessment of reimbursement differences between:
- Hospital outpatient departments
- Independent imaging centers
- Physician offices
- Ambulatory surgical centers
Imaging Revenue Integrity Analysis
Identification of
- Underbilling opportunities
- Missed charge capture
- Income lost due to technical components.
- Modifier optimization opportunities
Common Findings Identified During Radiology Audits
CPT code not properly selected
- Modifier 26 and TC not provided or not correct
- Documentation of medical necessity that is not supported
- Duplicate imaging submissions
- Unbundling errors
- Failure to code contrast administration
- Forgetting to code interventions
- Prior authorization discrepancies
- Professional or Technical mismatches
- Inconsistencies among reports and claims
Ready to strengthen your revenue cycle?
Let our specialty billing team handle the codes, claims, and follow-ups — so your clinicians can focus on patients.
Industries We Serve
Independent Imaging Centers
- Diagnostic Radiology Practices
- Hospital Radiology Departments
- Teleradiology Providers
- Multi-Specialty Physician Groups
- Academic Medical Centers
- Interventional Radiology Practices
- Outpatient Imaging Facilities
- Critical Access Hospitals
- Ambulatory Care Networks
What We Cover
Targeted and Routine Oversight of Payer Changes
Targeted and Routine Oversight of Payer Changes
Our teams monitor:
- Medicare updates
- Policy changes by commercial payers
- NCCI edits
- Imaging reimbursement trends
- Regulatory developments
What We Cover
Data-Driven Audit Reporting
Increase Clean Claim Rates
- Minimize unnecessary denials with accurate claims and coding.
Maximize Appropriate Reimbursement
- Capture all eligible reimbursable opportunities, avoiding non-compliance.
Reduce Compliance Exposure
- Reduce audit liability for Medicare, commercial payers and regulatory bodies.
Optimize Revenue Cycle Performance
- Improve turnaround for payments and minimize denied claim rework.
Data-Driven Audit Reporting
Here are some of the actionable dashboards you'll receive:
- Coding accuracy scores
- Denial trends
- Revenue recovery opportunities
- Compliance risk indicators
- Provider-specific performance analysis
Frequently Asked Questions
The diagnostic radiology, interventional radiology, neuroradiology, breast imaging, musculoskeletal imaging, nuclear medicine, pediatric radiology and teleradiology services are audited.
Contact ZechionMed
Talk to ZechionMed
Talk to ZechionMed about radiology claims audit.