Closing the Charge-Capture Gap
 Full charge-capture has become a must for today’s radiology practices. In addition to affording the obvious advantages of improved cash flow and lost-income recovery, full charge-capture offers providers access to a more complete—and therefore, more accurate—complement of data for use in negotiating with hospitals and payors, assessing physician productivity, and formulating staffing decisions.
JoAnn Berk, senior vice president of client services for Dominion Medical Management, Inc. (DMM; Milwaukee, Wisconsin), a revenue-cycle–management company, says that technology has significantly enhanced the charge-capture process. However, she notes that potential gaps in data flow—coupled with a tendency, among hospitals, to alter revenue categories or make other changes and about which practitioners are often the last to know—make a strong case for managing the charge-capture process with a system steeped in additional analytics.
Berk cites, as an example, a practice that employs 18 radiologists, maintains several freestanding imaging centers, and serves four hospitals. The group was experiencing a high volume of lost charges, and it turned to DMM when its third-party billing company was unable to determine why this was occurring or how to rectify the situation. As it does for all new clients, DMM first determined how the hospitals’ IT departments would identify appropriate files for its use. DMM asked many questions, Berk notes, “to ensure that all possible modalities, contracts, and group reading physicians, including locum tenens, were included. We will often identify potential problems up front and will make sure we get the correct data in our incoming files.”
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An IPA Leverages the Benefits of Information Sharing
 It has long been said that information is power, and if that is the case, actionable information is even more powerful. For members of independent physician networks, such data are the linchpin in achieving alignment with hospitals, leveraging relationships, attaining preferred status with payors, and more.
Michael Repka knows this all too well. Repka is executive director and CEO of Independent Physicians Network (IPN) Inc (Milwaukee, Wisconsin), a consortium of about 1,000 primary-care and specialist physicians providing services to patients throughout Wisconsin. Primary-care physicians constitute about 30% of IPN’s members; specialists, about 60%. IPN member physicians currently are engaged in data sharing at the emergency-department level, with the help of one health information exchange (HIE).
This strategy, Repka says, has led to a reduction in the delivery of duplicate services because it allows decisions about patient care to be formulated with all of the necessary facts at hand. It also boosts the potential for suggesting and executing alternative, more cost-effective treatment, in many cases. IPN, however, has bigger information-sharing goals in mind. RadAnalytics recently interviewed Repka to discuss IPN’s plans.
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A Merger Born of Data Analysis
The merger/acquisition market is heating up in radiology. Over the past few months, several mergers of large practices have created even larger ones, and other groups are likely to be considering similar moves. While entering into a merger agreement has its benefits, though, not all potential partners are entirely suited for each other. Moreover, even if proceeding with a merger of two or more radiology practices appears to be a wise course of action, many factors must be taken into consideration if the new entity is to be a success. Harnessing analytics to assess the viability of a merger—as well as to identify any necessary operational adjustments, going forward—is therefore prudent.
Radiology Associates of Tarrant County, Southwest Imaging and Interventional Specialists, and Grapevine Radiology Associates followed such a course of action prior to merging their respective practices in March 2011. Headquartered in Fort Worth, Texas, the group now operates under the name Radiology Associates of North Texas.
Employing 110 board-certified radiologists and 260 additional medical and administrative staff, it is the largest radiology practice in the state of Texas and is currently one of the largest in the United States, based on a 2010 survey1 of US radiology practices published in Radiology Business Journal. Lynn Elliott, CEO of the new group, says, “Mergers are not for the faint of heart, and radiology practices are bound to encounter hurdles, even with the best of possible matches. The more analytics you look at ahead of the game, the smoother the ride.”
Early in the discussions about the proposed merger, executives of all three practices (along with a financial analyst) formulated revenue assumptions for the new venture. These assumptions, however, did not take into account the different contracted rates that each player had set with various managed-care payors. “We looked at each group’s volume versus the contracted rates that would be in place following the merger, which gave us a good feel for top-of-the-line revenues and, indeed, validated our assumptions,” Elliott observes.
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Open Denial Accounts By Employee Queue
In many practices, each medical billing staff member who is responsible for individual billing charges is also responsible for managing any denials that arise from these charges. Some medical billing staff are better able than their colleagues to keep up with denied charges, but monitoring open denial accounts by employee allows practices to monitor and rebalance workloads as necessary.
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Imaging Coalition Rejects MedPAC Recommendation
The Imaging e-Ordering Coalition is urging the Medicare Payment Advisory Commission to abandon its recommendation that practitioners who order high levels of imaging be required to obtain prior authorization. The coalition—an alliance of providers, companies, and associations that includes the ACR®—favors the implementation of clinical decision support as an alternative to prior authorization.
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Itemized Reporting Is a Must for Radiologists
Image interpretation should remain a task solely for radiologists, who should use itemized reporting and standardized language to produce clear and unequivocal reports, according to the results of two surveys published in the April issue of Radiology.
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