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 important as reimbursements continue a downward trend and payors continue to impose additional administrative requirements.
Automation has been highly successful in a number of key process areas. What are they, and why are they important?
Data Acquisition and Reconciliation
Radiology was one of the more progressive medical specialties in terms of downloading demographic information, although virtually every group will confirm that a certain portion of its business is still derived from paper documentation. Changes, however, have been appreciated in several key areas, including electronic report acquisition, optical character recognition/scanning, and reconciliation.
Recommended compliance practices call for coding from radiology reports, rather than from hospital charge documentation. Voice-activated dictation has facilitated the acquisition of digital report documentation, with the result that charge and coding information files are brought into the billing system within minutes. In contrast, the previous scenario of sorting large volumes of paper reports for coding and charge entry could literally take days—and several staff members.
Even when radiology reports are not available in digital formats, they can be scanned by intelligent software capable of sorting files and matching them to demographic information by patient. While scanning is less efficient than digital data acquisition, it greatly streamlines processes when electronic report versions are not available. Again, this process reduces the number of staff members involved in data sorting, matching, and entering information for billing.
Missing charges are a source of concern for any hospital-based group, and paper-based processes for matching demographics and radiology reports are cumbersome, as well as ineffective. Before technology was used, this meant retaining stacks of paper order/demographic forms and sorting through them daily as new radiology reports were received—or at best, attempting to enter reports into the system and matching them to demographic files based on several match criteria. As reconciliation processes were automated, they were also enhanced, in terms of the ability to validate data capture with several source documents, including demographic files, department log sheets, and/or information from the radiology information system or PACS.
Some of the greatest billing-efficiency gains have occurred at the data-acquisition phase, with measurable results of
reductions in staffing
improvement in the timeliness of claims preparation and submission, and
reductions in lost charges.
Coding and Charge Entry
Accurate coding is at the core of the billing process, especially in terms of ensuring that each procedure dictated by the radiologists is adequately documented and submitted as a charge. Dramatic changes have occurred in the automation of coding and charge-entry processes.
Technology has facilitated the coding process by reading a report and assigning appropriate procedure and diagnosis codes for review. Organizations have been able to leverage the efforts and experience of their coders by moving them to a position of reviewing/approving simpler procedures coded by the technology and allowing them more time for the more complex procedures requiring human intervention to assign codes.
The ability to use technology for sorting also has enabled larger organizations to sort and assign work by modality, with the result that coders can specialize in certain areas and complete coding assignments more efficiently when they are not moving constantly among widely varying modalities.
In most of the advanced billing systems, demographic information and reports are displayed side by side. Codes are simply entered into the charge screen during the coding process and the claim is released. In contrast, older processes required passing stacks of paper from the coding department to charge entry and could take multiple days to complete.
Claims Editing and Electronic Submission
Automated claims-editing procedures have been credited with improving cash flow and reducing the number of insurance