Achieving True Transparency in the Radiology Billing Cycle
Transparency is a term that can be applied to almost any aspect of a business’ operations, and while it is always a worthwhile goal, it is particularly important for radiology practices to embrace and achieve transparency when it comes to the billing cycle. A practice’s financial health is significantly improved by an ongoing understanding of the fluctuations that make up the revenue cycle; further, this transparency enables the practice to take a proactive approach to addressing problems that stand to affect the bottom line. Too many radiology practices still operate using a piecemeal approach to the revenue cycle, with each component being the responsibility of a different individual or group, preventing key stakeholders from seeing the big picture. For instance, an inefficient patient-registration process can lead to demographic errors that result in claim denials, negatively affecting the practice’s days in accounts receivable. When these processes are transparent and visible on a day-to-day basis, on the other hand, problems can be mitigated before they translate into revenue loss. Data Integrity Critical to ensuring transparency throughout the revenue cycle is data integrity. In this context, data integrity means ensuring that all data related to billing are as complete and accurate as possible, and that mistakes can be caught early, before claims enter the cumbersome payor denial-and-appeal process. Data integrity begins in the front office with patient registration. Demographic errors can have a significant impact on a claim’s viability down the line; practices can ensure clean registration by automating the process as much as possible and ensuring that patient information—including name, Social Security number, and insurance coverage—is confirmed or updated by the patient at each visit. Another critical area for practices to focus on is preauthorization from payors. Now required for many high-tech imaging procedures and clinical indications, preauthorization letters constitute a balancing act involving the referring physician, the payor, and the radiology practice. Without the proper preauthorization in place, denials will occur downstream, and details are critical: For instance, we have seen denials over problems as small as whether a CT procedure was preauthorized to include contrast. Coding is perhaps the most important area in which to ensure data integrity. Many practices audit their coders on an annual basis, but this is not sufficient to keep pace with the constant regulatory changes. Coding audits should be performed on a quarterly basis, and coders should receive proactive training to ensure they are ahead of any changes that could result in denials. Interventional coding is particularly vulnerable to error because of its complexity, and it deserves extra attention and diligence. This process helps eliminate risk, and when risk is identified, the practice can create a plan of action to address it. Business Intelligence With data integrity ensured, a radiology practice can place more trust in (and be more responsive to) the business intelligence provided by its billing data. Business intelligence has a variety of applications for the savvy practice, but when it comes to billing transparency, reporting should be used to give stakeholders a daily snapshot of the practice’s financial performance, enabling them to identify potential issues at an early stage. For many people, the very words business intelligence bring to mind dense, 50-page quarterly reports that take hours to parse. While these reports have their uses, they are not the information to which we refer when we discuss transparency. In fact, in order to achieve true transparency in the billing cycle, practice stakeholders should focus on a few key pieces of easily digestible information that can be monitored daily. The first of these is the practice’s modality mix. This information should include procedures by modality, charges and payments by modality, how the modality mix has changed over time, and how RVUs have shifted. Monitoring this information gives stakeholders an at-a-glance understanding of productivity and utilization, and it enables them to spot opportunities for future growth (as well as modalities that are underperforming). The second is payor information, including payments per procedure by payor and overall revenue captured by payor. This information gives stakeholders an understanding of which payors are performing best and which might be underpaying, enabling the practice to approach problem payors proactively and work to reach a solution. The third is collections (with accounts receivable). These data provide the closest thing to a snapshot of the practice’s current financial health available, showing—over time—procedures, charges, payments, refunds, and bad debt, and charting these over the course of months or years to allow stakeholders to identify trends. These measurements are easily digestible and rapidly expose problems that the practice needs to address to increase revenue. Quality Assurance In addition to regular coding audits, radiology practices can ensure billing transparency through other quality-assurance initiatives, including annual reviews of claim submission, random HIPAA compliance, and billing-center security. Charge-capture audits can help the practice understand how well it produces appropriate claims for services, and a comparison of the CPT® codes billed by radiologists with those billed by the hospital for its global services can reveal any discrepancies or errors that might lead to denials down the line. The health-care climate has changed significantly, and radiology practices can no longer afford to leave dollars on the table. Even seemingly trivial sums, such as patients’ copayments for procedures, can add up to significant revenue-cycle problems if process errors are preventing their timely collection. Billing transparency—made possible by clean data, manifested in key analytics that can be reviewed daily, and reinforced by quality-assurance processes—will enable practices to mind the pennies that quickly add up to dollars, ensuring that all possible revenue is captured with efficiency and accuracy. Carrie Moneymaker is an operations manager with Medical Management Professionals.