Maximally Correct Coding and Reimbursement. Actual clinical utilization is often left unbilled, either (correctly) because it isn’t documented, or (incorrectly) because of systems issues that somehow preclude the service(s) actually ordered, provided, and documented from being correctly billed.

Because reimbursement is impacted directly by accurate coding, this also falls under the CRO’s responsibilities. Practices will frequently send coders, technologists, and providers to coding conferences or other educational sessions, and even bring in an outside consultant or two. As the new CRO, I am implementing a year-round audit program that is designed to systematically review the effectiveness of these educational activities and processes by assessing if what was actually performed was documented in full and then was translated into the correct CPT and ICD-9 codes billed to payors. Inconsistencies—or gaps—between operations and coding, IT interfaces and coding, and coding and charge posting will be fixed by having a dedicated senior administrator at the table who’s role it is to facilitate cross-functional solutions to these types of systems issue.

This same process will also evaluate the actual payments remitted for services billed against the payor’s contractual allowable, and will resolve underpayment issues as identified. Every practice should have some form of audit process—concurrent and/or retrospective—as claims submission and payment with 100% accuracy is very rare indeed.

Efficient Back-Office Operations. The size of the business office measured in terms of percent-of-payroll varies by practice and business model, but in Inland’s case, it is the largest single department and commands close to a third of its payroll expense.

For a practice as large as Inland’s, one or two extra billing office staff is not a make-it-or-break-it proposition. But, too few staff or staff not efficiently working to capacity can have a significant negative impact on the fiscal performance of the practice, if not in terms of wage expense, then in accuracy of claims billed, correct collections, accounts receivable (AR), and cash management.

Part of my role is to ensure that the business office is performing its role as efficiently and accurately as possible.

Informatics. I think the key to the position of CRO is that he or she understands many forms of relevant data, including financial, clinical, and other external data of market or marketing relevance, and can translate this understanding of the data into analysis that leads to practice improvements, marketing improvements, and better financial management.

I believe this is where the true value lies for the CRO: improving revenue through meeting the unmet needs of the patient, taking care of the interests of the health plan in ensuring a provider network that delivers the highest quality of care, as well as meeting the needs of the other administrators and department heads. Well-analyzed data can lead to new innovations, process improvements, and accurate and timely reimbursement.

I would encourage practices that are considering how to make sure they are maximizing revenue for services provided or looking for new ways to increase value to both patients and payors to consider hiring a CRO. Accurate, efficient, and fast collections will have a new champion at the table who can focus the appropriate time and energy to resolving systems issues that often make this goal challenging.

I personally would appreciate having company and look forward to the day when there is a Radiology Business Management Association forum for CROs. Maybe someday soon.

Dan Heibert is chief reimbursement officer for Inland Imaging in Spokane, Wash.