Overview

Part of the Defensible Healthcare Billing Series Radiology reimbursement is uniquely measurable, structurally divided, and heavily scrutinized through automated payer analytics. Payment depends not simply on image acquisition, but on the alignment of clinical indication, supervision compliance, professional interpretation, component billing structure, and medical necessity logic. When these elements misalign, claims become vulnerable to denial, recoupment, and expanded audit review. Defensible Healthcare Billing: Radiology Services provides a structured, code-agnostic framework for constructing radiology claims that are accurate, aligned, and defensible. Rather than focusing on proprietary coding manuals, this book explains how radiology reimbursement actually functions under review and why documentation structure determines payment eligibility. Section I establishes the structural foundation of radiology billing, including professional and technical component distinctions, supervision standards, split versus global billing methodology, bundling logic, anatomical overlap risk, frequency controls, diagnosis-to-modality alignment, and documentation standards for defensible interpretation. Readers learn why the written report-not the image itself-represents the true billable event and how minimal documentation invites audit scrutiny. Section II examines audit reality. It analyzes how radiology audits originate, common denial triggers, utilization analytics, documentation requests, extrapolation risk, appeal strategy, prepayment review, and compliance program development. Emphasis is placed on pattern recognition, structural governance, and preventive controls rather than reactive correction. Written for radiologists, coders, auditors, compliance officers, revenue integrity leaders, imaging center administrators, and healthcare executives, this volume bridges the gap between technical billing knowledge and real-world audit exposure. As part of the Defensible Healthcare Billing Series, this book applies a consistent specialty-focused methodology designed to help healthcare professionals construct, evaluate, and defend claims with clarity, discipline, and long-term compliance strategy. Radiology is measurable by design. Defensibility must be intentional.

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About the AuthorLinda Myrick, CPC, CPC-I, is a healthcare billing and compliance professional specializing in defensible reimbursement strategy, audit response, and revenue integrity. With extensive experience in specialty-based billing structures, she focuses on translating complex reimbursement systems into practical, audit-ready frameworks that withstand payer scrutiny.Her work centers on the intersection of documentation, compliance, and financial accountability. Rather than teaching billing as code memorization, Linda emphasizes structural logic-how claims are built, how payers evaluate them, and where organizations most often face risk exposure. Her approach reflects real-world audit patterns, denial behavior, and payer analytics, equipping professionals to move from reactive correction to proactive compliance.Linda has worked with coders, clinicians, auditors, and revenue cycle leaders across multiple care environments, helping organizations strengthen documentation alignment, reduce recoupment exposure, and improve billing defensibility. She is particularly known for clarifying high-risk areas such as time-based reimbursement, provider role designation, bundling logic, medical necessity alignment, and audit escalation management.As the author of the Defensible Healthcare Billing Series, Linda develops specialty-focused guides designed to bridge the gap between technical billing knowledge and audit reality. Each volume applies a consistent, code-agnostic methodology that prioritizes clarity, accountability, and sustainable compliance across payer environments.Her mission is to empower healthcare professionals to understand not just how to bill, but how to defend their decisions confidently under review.

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