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Calendar April 17 - 21, 2023
location Chicago, IL

Radiologists should be concerned about billing and collecting revenue in 2022, as well as operating more efficiently and complying with certain CMS initiatives. One source of concern is the “snail-like” communication that occurs between referring physicians and the radiology practise when orders and information are submitted via email on multiple computers. It is typically slow, and data can be lost during translation.

This back-and-forth with referring physicians’ orders and occasionally overlooked emails results in (1) many hours lost, (2) failure to proceed with necessary imaging, and (3) claims not being approved by insurance payers.

Add to that a slew of new rules for the 2022 fiscal year, not the least of which are reimbursement cuts.

Indeed, the cuts could have been worse if they had been implemented as originally planned, but reimbursements will be reduced.

And, of course, insurance companies will almost certainly deny the imaging center’s claim if the exact correct code is not entered.

Radiology is looking towards RCM Services

Outsourced revenue cycle management (RCM) services are becoming more popular. The billing reimbursement process can be vastly improved when utilising a radiology-oriented RCM. Empowering the imaging centre to focus more on quality and patient care and less on drudgery-laden, back-of-the-house routines by the RCM team working in the background helps to alleviate staffing issues and expense on the imaging side.

Staff time spent obtaining eligibility verifications, prior authorisations, claim scrubbing for maximum claim value and ensuring they’re “clean” for submitting, tracking claims once they’re submitted, dealing with denials and appeals, reconciling EOBs, and then working balances once they become the patient’s responsibility can all be off-loaded if the RCM service has the team and AI-driven technology to handle it.

For radiology, the RCM service must handle HCFA, UB, workers’ compensation, and no-fault claims. It should have access to an accurate insurance discovery mechanism to locate coverage if it is completely or partially unavailable for the patient.

The importance of keeping referrers referring cannot be overstated by imaging centers. One way to accomplish this is to allow referrers to send orders directly from their EHR to the imaging center’s RIS. The imaging side would then transmit finalised reports back to the referrer’s EHR without the need for any costly HL7 interfaces. Of course, a referring physician portal is another critical piece of technology.

Last but not the least, keeping patients connected and mobile is, without a doubt, critical to their having a positive experience with the imaging center. Patients will have a better experience if they can log into a portal ahead of time, schedule appointments, fill out surveys, and make payments using their mobile devices.

At smartData, we have developed multiple solutions based on RCM, medical billing, radiology for our customers. Recently, we are also working on implementing robotic process automation into billing domain. Connect with us to automate the healthcare processes.

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