Modifier-driven edits and TC/26 splits cost radiology groups recoverable revenue on every read.
Radiology billing lives and dies on modifier accuracy. Technical vs. professional component splits, multi-procedure reductions, and advanced imaging auth failures generate systematic underpayments that compound across high-volume reads. Ember catches every one.
Trusted by specialty groups and health systems
Where radiology revenue leaks
The denial patterns Ember was built for
High read volumes amplify every coding error. Modifier mistakes and multi-procedure reductions that seem small per claim become systematic underpayment at scale. Ember closes each gap.
01 · TC/26 modifier splits
Improper billing of technical and professional components.
When the reading physician and the facility are billed separately, correct modifier 26 and TC application is critical. Errors generate claim rejections or inappropriate bundling of the professional read into the facility fee. Ember validates every split-billing claim against payer-specific rules before submission.
Mod 26 · Mod TC · 70471 · 7125002 · Multi-procedure reductions
Systematic underpayment when multiple imaging studies are read in the same session.
Payers apply multi-procedure payment reduction rules to imaging reads, but the rules differ by payer and are frequently misapplied, resulting in underpayment rather than the correct reduction. Ember validates each multi-study claim against the applicable payer rule and identifies underpayments at the line level.
Mod 51 · Mod 59 · 73721 · 7417703 · Advanced imaging prior auth
Auth failures on CT, MRI, and PET studies ordered by referrers.
Advanced imaging orders arrive with varying levels of documentation supporting medical necessity, and auth obtained by the ordering physician may not satisfy the radiology payer's criteria. Ember validates auth status and clinical documentation before the study is performed, not after the claim is denied.
70553 · 74177 · 78816 · 71250Three engines.
One source of truth.
Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer. Built for the read volume and modifier complexity radiology billing requires.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every encounter and provider.
R. Okafor
Read #R-50218
02 · Audit
Coding Engine
Reviews 100% of encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.
Append modifier 26 — professional component
CMS MPFS · confidence 0.97
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the applicable LCD/NCD policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #R-50218 · Denial CO-4
The professional component is correctly reported with modifier 26 per MPFS payment policy and contract §4.2…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for radiology groups. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the modifier issue before the claim leaves.
Ember reviews every read against coding standards, payer imaging policy, and your contracts. TC/26 splits, multi-procedure reduction calculations, and auth status are validated before submission.
- 1
Ingest the encounter
Pulls radiology reports, codes, and modifiers from your RIS, EHR, and practice management system.
- 2
Validate against rules
Checks TC/26 modifier application, multi-procedure reduction calculations, auth status, and global vs. split billing against each payer's specific rules.
- 3
Recommend with citation
Returns the suggested correction tied to the exact payer policy, LCD/NCD reference, or contract term.
- 4
Educate the team
Coding patterns drive team-level coaching, so modifier accuracy and auth documentation improve across every radiologist and site.
Append modifier 26 — professional component
CMS MPFS · confidence 0.98
+23%
Clean-claim rate
100%
Encounters reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves radiology reports and ordering-physician notes, references payer imaging policy and contract terms, drafts the appeal, and tracks it through adjudication.
Modifier missing
Auth not on file
MPPR misapplied
TC/26 split
Modifier 26 appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per appt
The full revenue cycle
From eligibility to adjudication. Covered.
Audit and appeals are the workhorses, but Ember protects radiology revenue at every stage of the cycle.
Eligibility Verification
Confirms active coverage and imaging benefit status before the study, and flags coverage gaps before they become billing problems.
Prior Authorization
Validates auth status for advanced imaging orders, checks clinical documentation against payer criteria, and flags gaps before the study is performed.
AI Medical Coding
Reviews 100% of reads, CPT codes, modifiers, and TC/26 splits, against national standards and payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching modifier errors, multi-procedure reduction miscalculations, and auth failures before they generate write-offs.
Denial Management
Full appeal lifecycle for every radiology denial type, modifier dispute, auth failure, medical necessity, and bundling error, tracked to adjudication.
Underpayment Recovery
Parses contracts to model what each imaging claim should pay, then surfaces TC/26 and multi-procedure underpayments at scale.
Modifier-driven revenue, recovered at scale
-57%
denial rate
-45%
cost to collect
100%
reads audited
7 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
See what your radiology group is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.