Mary Suhr and I had a great time presenting “Lost Before the Scan: The Hidden Leaks in Radiology Revenue” at the AHRA Annual Meeting today. Our goal was to pull back the curtain on how much revenue radiology departments lose before a patient ever reaches the scanner and why so much of it never shows up in denial reports the way you’d expect.

We started by walking through what the pre-scan workflow looks like on paper versus what it actually takes operationally: scheduling, order review, insurance verification, authorization, and check-in. We talked about how clinical and nonclinical staff depend on one another to get it right. From there, we dug into order intake, using real-world examples from the emergency department, primary care, and orthopedics to show how vague or incomplete orders ripple downstream into wrong appointment types, incorrect authorizations, and same-day changes that lead directly to denials.

A big focus of the session was order scrubbing. We made the case for reviewing orders within 48 hours of scheduling, or even before scheduling, rather than waiting until 48 to 72 hours before the actual exam, since that extra runway is what prevents rushed, inaccurate authorizations and last-minute patient estimate issues. We also spent time on referring provider relationships, since so much of “bad” order behavior traces back to root causes like frustration with read turnaround times or high-volume clinic days rather than carelessness.

The second half of the session got into the weeds on authorization accuracy and validity, time-of-service check-in pitfalls (that “Is your insurance still XYZ?” question is doing more harm than people realize), and one of my favorite parts: charge capture blind spots. Mary showed how orders that are only built out to a single CPT code can silently drop charges for guidance, injections, or contrast supply on interventional studies. We walked through a full example of a CT-guided MR arthrogram to show exactly where those charges disappear.

Mary and I both wanted attendees to leave with a clear message: Most front-end revenue leakage isn’t a denials problem; it’s a workflow and build problem, and it’s fixable with the right checks in place. Thanks to everyone who came out and asked such great questions today!

Ashley Hunter, MBA, CHFP, CRCR
Senior Revenue Cycle Consultant
RCCS/R3/Regents

Mary E. Suhr, MBA, CPC, RCC, RCCIR (she/her/hers)
RCM Business Operations Director
Revenue Cycle Coding Strategies