Revenue-cycle Management: Minimizing Denials and Maximizing Collections

November 28, 2011 | Feature

The best way to minimize denials is to prevent them in the first place, by making sure that medical claims meet the requirements for clean claims. A clean claim is defined as a claim that meets the standards required by insurance carriers for payment on first submission.

The Mystery of the Missing Collections

September 04, 2011 | Feature

How well do you really know your payors? A recent analysis for one practice turned up some very interesting revelations with operational ramifications for the provider, but this was possible only because the provider had access to the entire fee schedule of the insurance company.

The larger... Read More »

Better Business Intelligence: Enhanced CPT Code Analysis

July 16, 2011 | A Better Mousetrap

This article is the first in a two-part series about how radiology practices can derive superior business intelligence from their existing coding and payment data.

Historically, radiology practices have looked at CPT® code volume as a measure of work. As Greg Thomson, CPA, executive vice president of... Read More »

The Other Data Deluge: ICD-10

July 04, 2011 | Priors

In his preview¹ in Health Affairs of the impending data deluge scheduled to begin with the transition to ICD-10 on October 1, 2013, Harris Meyer explains that the international disease-classification system dates back to 1763, when—in an act of altruism toward his fellow physicians—Francois Boissier de Sauvages de Lacroix (1706–1767)... Read More »

The Next Generation of Outsourced Billing

October 11, 2010 | Revenue Track

The decision to outsource billing is one faced with increasing regularity by radiology groups seeking to trim costs while maximizing reimbursement. Within this larger decision also lies another conundrum: how to select the outsourced-billing approach that best suits the practice. Kevin Shepherd is chief development officer for Read More »

Price Transparency Gains Traction

May 17, 2010 | Imaging Futures

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. The concept is to apprise patients of their out-of-pocket costs before they schedule appointments.... Read More »

Lost in Transcription

May 17, 2010 | Revenue Track

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. Radiology is one of the most high-volume specialty areas in terms... Read More »

Preventing a MAC Attack: The Importance of Radiology Charge-capture Audits

January 26, 2010 | Reimbursment

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. This affects many areas, but arguably, none more greatly than outpatient diagnostic and interventional-radiology services. Hospitals and physicians encounter many challenges in... Read More »

Strategies for Accommodating Self-pay Patients

January 18, 2010 | Revenue Track

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, according to Randal Roat, CHBME, and Jana Landreth, CPA, MBA, of Medical Management Professionals (MMP), a physician billing and practice-management company... Read More »

Taking Advantage of the Radiology Audit

August 17, 2009 | Revenue Track

A radiology provider should look at an audit as a strategic opportunity, not a punishment, Claudia A. Murray, RCC, told her audience at the RBMA 2009 Radiology Summit in Orlando, Florida, on June 8. Murray, who presented “Internal Compliance Auditing: How to Implement an Effective (and Doable) Audit Plan,” is a... Read More »

RBMA Attendees Debate Outsourced Billing

July 15, 2009 | Revenue Track

It is a question often pondered by practice managers and others overseeing the financial aspects of an imaging enterprise: What guidelines or benchmarks do I use to determine whether to retain my in-house billing department or outsource billing? At a June 9 session at the RBMA conference in Orlando, Florida,... Read More »

Managing Errors in Demographic/Clinical Information: Using Tracking Mechanisms

June 15, 2009 | Revenue Track

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).

Advisory Opinion Muddies the Waters on Preauthorization

January 15, 2009 | Regulatory Report

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 HHS OIG concluded that it would not penalize the arrangement, even though it did not qualify under any... Read More »

Using Adjustment Coding to Manage Practice Compliance

January 15, 2009 | Revenue Track

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. This article will move the telescope a little farther away to illustrate quick ways to check how the revenue system... Read More »

ICD-10 Mandate to Break Physicians’ Bank

November 16, 2008 | Dashboard Confessions

The typical 10-physician practice will spend $285,240 to comply the new federal mandate to adopt the ICD-10 code set by 2011. The controversial proposal from HHS would significantly increase costs for physician practices and clinical laboratories, according to a new cost study initiated by a broad group of provider organizations and... Read More »

Keep Payors Honest With the Practice Receivable System

October 16, 2008 | Revenue Track

It is not a completely fair analogy, but the differing agendas of payors and providers place receivable processing in something of a battle zone. The payors seek to limit payments to no more than absolutely necessary to cover the contractual benefits of their beneficiaries. They put up a gauntlet... Read More »

ICD-10 Deadline Brings on IT Headaches

September 16, 2008 | Dashboard Confessions

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.

Not only does ICD-10 contain 10 times the number of codes in... Read More »

Collecting Self-pay Balances: Cash Is King

August 15, 2008 | Revenue Track

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.

Yes, there may be that many people without any third-party coverage, but there is a much larger group of individuals who fall into... Read More »

Contract Negotiations: Not Just About the Dollars

June 12, 2008 | Radiology Business Journal

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.” Payors seem to hold all the cards in any... Read More »

Proper Coding Delivers Big Results

May 15, 2008 | Revenue Track

Correct procedure coding is a primary, and pivotal, activity among providers and payors alike. Undercoded claims leave money on the table, while overcoded claims leave the practice exposed to financial risks, including potential accusations of fraud. If a practice spends too much time on coding, reporting, reviewing, scheduling, code... Read More »

Radiology Coding and Compliance for 2008

March 15, 2008 | Revenue Track

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. In 2008, there continue to be many reimbursement, coding, and compliance challenges for radiology organizations. This article... Read More »

Process Automation: The Key to Improved Financial Performance

February 15, 2008 | Revenue Track

The high procedural volumes associated with radiology provide both a challenge and an opportunity. The old days of handling paper persist to varying degrees, but organizations investing in technology to automate common processes have demonstrated an ability to improve productivity and profitability while decreasing associated costs. This is especially... Read More »

ARA Floats an Automated Billing Process… And Inhales

August 15, 2007 | Radinformatics

The 65-radiologist Austin Radiological Association is well known for its robust information technology deployment throughout central Texas. Nonetheless, the practice’s billing department, which billed close to a million procedures last year, was awash in the same paper that plagues smaller, less sophisticated practices. Enter Laura Casey, business office... Read More »