by Curtis Kauffman-Pickelle
Today’s medical-imaging profession is definitely not for the fragile and weak-kneed among our colleagues. It is becoming increasingly clear that navigating the constant changes and challenges that face the practice of radiology today will be the ultimate test of tenacity, perseverance, and creativity. We’re in the playoffs now, and the game is moving to the big-time arena—where the margin for error is nil.
by Cheryl Proval
Physicians are in a real bind as fee-for-service reimbursement falls under attack and alternative payment methods (such as bundling and capitation) gain traction in Washington, DC. As of June 18, Medicare Part B claims were being processed with the 21.3% cut mandated by the sustainable growth rate’s formula, and House Democrats demanded legislation on jobs before they would pass the Senate bill to reverse the cut.
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Randy Roat, CHBME, VP of Radiology, MMP, and George Ehrhardt, CPA, Director, Practice Management, MMP
Medical Management Professionals, Inc.
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Owing to a confluence of market forces, industry innovation, and government action, consumers in more than half of US states now have at least some ability to see procedure charges in advance.
Charge reconciliation—the practice of identifying procedures that have slipped through the cracks at some point in the charge process and billing for them to optimize revenue—is important for any medical group, but particularly critical for imaging.
The advent of Medicare administrative contractors has emphasized the importance of ensuring that charge capture is consistent and accurate for the professional and technical components of care.
As the ranks of the uninsured continue to grow, it is increasingly important for radiology practices to implement strategies for dealing with self-pay patients.
A radiology provider should look at an audit as a strategic opportunity
It is a question often pondered by practice managers and others overseeing the financial aspects of an imaging enterprise:
All insurance accounts fall into one of two groups: full resolution (at negotiated fees, where the credits only consist of cash, contract adjustment, and probable bad debt, if any patient balance cannot be collected) or full write-off (where the practice did not comply with a payor-based rule).
After reviewing a proposed arrangement pursuant to which a company would handle the processing and submission of insurance preauthorizations for various imaging services for the benefit of multiple imaging centers.
The October 2008 ImagingBiz.com article Keep Payors Honest With the Practice Receivable System concentrated on advanced techniques for monitoring the insurance companies that compensate radiologists for their clinical services.
The typical 10-physician practice will spend $285,240 to comply the new federal mandate to adopt the ICD-10 code set by 2011.
It is not a completely fair analogy, but the differing agendas of payors and providers place receivable processing in something of a battle zone.
No sooner did CMS call for an October 1, 2011, compliance date for the switch from ICD-9 to ICD-10 codes than a hue and cry arose from the health care industry, claiming that the change comes too soon.
You cannot pick up a newspaper today without reading about the 47 million uninsured US residents. Well, that is only the tip of the iceberg.
Contract negotiations with payors formerly were a lengthy process. Not any more; they are concluded now in half the time because payors have stopped telling radiology groups to take it or leave it and, instead, are simply saying, “Take it.”
Correct procedure coding is a primary, and pivotal, activity among providers and payors alike.
Every year, radiology professionals who are responsible for ensuring the accuracy and compliance of coding and billing practices must do an internal assessment to ensure that their practices/organizations would withstand external scrutiny.
The high procedural volumes associated with radiology provide both a challenge and an opportunity.
The 65-radiologist Austin Radiological Association is well known for its robust information technology deployment throughout central Texas.