Routine radiology tests such as X-rays and ultrasounds are often viewed as low-cost services. But their high volume can make unnecessary testing costly for health plans and burdensome for patients. As Avalon’s James Long explains, these tests often receive less scrutiny than advanced imaging, even when they do not align with established clinical standards. In Avalon’s analysis of a commercial health plan, potentially avoidable routine radiology spending amounted to nearly $9 million annually per million members.
Health plans have an opportunity to address this gap without delaying care or adding prior authorization requirements. Automated review after a service is delivered but before a claim is paid can help identify tests that do not meet clinical criteria, while giving providers feedback to support more appropriate ordering. Learn more about the hidden costs of routine radiology and approaches to managing them in Long’s article in Managed Healthcare Executive.
