Radiology billing is uniquely complex. Most hospitals are getting it wrong.
Medicare’s Hospital Outpatient Prospective Payment System (HOPPS) governs how hospitals are reimbursed for imaging services, and its complex rules around cost centers, APC groupings, and charge capture often leave significant revenue unclaimed. Success isn’t about working harder - it’s about having the specialized expertise to navigate a system built on structure, not effort. For Critical Access Hospitals, the rules shift entirely: volume doesn’t matter, but cost accuracy does. Our expertise ensures both environments capture the full reimbursement they’re entitled to.
Cost Center Misclassification
Radiology modalities billed under incorrect cost centers generate systematic reimbursement shortfalls that compound annually. Most hospitals have never had their cost center structure reviewed by an imaging specialist.
Coding & Documentation Gaps
Undercoded procedures, missing modifiers, and insufficient clinical documentation translate
directly to lower reimbursement. CPT and ICD-10 coding errors in radiology are among the
most common and most expensive billing mistakes in hospital systems.
Denial Patterns Left Unaddressed
Denied and underpaid radiology claims pile up without systematic analysis. What looks like isolated billing errors often reflects correctable systemic patterns - ones that can be appealed and prevented going forward.
Your hospital may be leaving millions on the table.
We find the missed imaging revenue others overlooked. Our
proven methodology has identified over $1M in additional annual
revenue for hospitals - without adding a single scan.
Imaging Reimbursement & Cost Optimization Services
1
OPPS Imaging Revenue Optimization for Major University Hospital Systems
Medicare’s Hospital Outpatient Prospective Payment System (HOPPS) is complex and even small structural issues in cost centers, APC assignments, or charge capture can quietly drain millions from large academic imaging programs. This isn’t about working harder; it’s about structuring your data so Medicare sees the true cost of the care you provide.
Why Structure Matters
Under OPPS, payment is driven by:
Cost center organization
Charge architecture
APC mapping
Accuracy of reported costs
When these elements are misaligned, CMS classifies imaging as “low‑cost,” lowering APC weights and long‑term reimbursement especially for hybrid modalities like PET/MRI.
What We Do
We help academic medical centers strengthen their OPPS imaging foundation by identifying structural gaps and aligning financial data with operational reality. Our work ensures your imaging program is represented accurately within Medicare’s payment system.
Services include:
Imaging cost center review
PET/MRI, MRI, CT, and PET alignment
Charge master refinement
APC mapping analysis
Radiopharmaceutical charge and waste review
Identification of under‑reported cost
Strategic recommendations to support future APC rate accuracy
What You Gain
More accurate Medicare cost reporting
Stronger APC payment weights over time
Better alignment between imaging operations and financial outcomes
Reduced leakage from under‑charging or mis‑grouping
A clear roadmap for sustainable reimbursement growth
Who We Support
Academic medical centers
Large hospital systems
Programs with PET/MRI or other hybrid imaging
Organizations preparing for expansion or modernization
Systems experiencing unexplained OPPS reimbursement declines
Let’s Strengthen Your Imaging Revenue
If your hospital is ready to improve OPPS accuracy and recover under‑reported cost, we’re ready to help with an approach that’s collaborative, efficient, and tailored to your structure.
2
CAH Imaging Cost Report Reconstruction & Cost Recovery
Critical Access Hospitals operate under a cost‑based Medicare model meaning reimbursement only reflects what’s actually reported. When imaging costs are missed, miscoded, or misallocated, CAHs lose reimbursement year after year without realizing it.
We provide the imaging‑specific expertise needed to ensure your reported costs accurately reflect the true resources required to deliver care.
What We Do
We review and strengthen your imaging cost structure, so Medicare sees the full picture.
Our support includes:
High‑level evaluation of radiology and nuclear medicine cost reporting
Identification of gaps or misaligned costs
Realignment of imaging cost centers
Review of radiopharmaceutical cost capture
PET, CT, MRI, and hybrid modality cost structure guidance
Recommendations to reinforce future cost reports
Documentation that supports finance teams and auditors
Our focus is simple: help CAHs secure the reimbursement they’ve already earned.
What You Gain
More accurate Medicare cost reimbursement
Recovery of previously unrecognized costs
Greater financial stability for imaging services
Clear, defensible reporting
A foundation that supports modernization and growth
CAHs deserve full recognition for the cost of the care they provide and we help make that possible.
Who This Service Is For
Critical Access Hospitals
Rural health systems
CAHs with PET, CT, MRI, or nuclear medicine
Hospitals preparing for cost report submission
Organizations facing unexplained reimbursement shortfalls
Strengthen Your Cost-Based Reimbursement
We make the process straightforward, collaborative, and tailored to your imaging program. When your CAH is ready to recover under‑reported costs, we’re ready to help.
3
Radiopharmaceutical Reimbursement & Charge Integrity Review
Radiopharmaceuticals are some of the highest‑cost items in imaging and also some of the easiest to mischarge. Even small gaps in charge capture can reduce reimbursement, weaken APC payment rates, and distort cost reporting. Not because hospitals are careless, but because radiopharmaceutical billing is uniquely complex.
We help simplify and strengthen this part of your program.
What We Do
We provide a focused review of your radiopharmaceutical charging and cost structure to ensure it aligns with Medicare expectations. Our work supports accurate charge capture, proper cost recognition, and stronger future APC payment rates across PET, PET/MRI, PET/CT, and therapeutic radiopharmaceuticals.
What You Gain
More accurate radiopharmaceutical reimbursement
Recovery of missed or under‑charged cost
Stronger APC payment weights
Clear, defensible documentation
Confidence in the financial structure of your PET and nuclear medicine programs
Who This Is For
Hospitals performing PET, PET/MRI, PET/CT, or therapeutic radiopharmaceuticals; CAHs with PET or SPECT; and organizations experiencing unexplained reimbursement variation or preparing for cost report/OPPS review.
Strengthen Your Radiopharmaceutical Reimbursement
Radiopharmaceutical charging doesn’t have to be complicated. We make it clear, collaborative, and easy to implement helping you secure the reimbursement you’ve already earned.