As a radiologist, you must have a sharp focus on getting every collectible dollar at a lower cost of billing. This is no easy feat as payment responsibility shifts from institutional payers to patients, whose dollars are more difficult to collect. An increasing number of consumer-driven, high-deductible health insurance plans, such as Health Savings Accounts (HSAs), mean mounting reimbursement pressures.
Whether you’re a general, sub-specialist or interventional radiologist, and regardless if you work with hospitals, imaging centers or outside facilities, you likely work in a high-volume practice. It’s important to capture, audit and process every procedure to maximize your income. After all, a missed charge from any facility means you’re working for free.
In today’s challenging health care environment, radiologists need expert insight to ensure consistent and cost-effective improvements in reimbursement.
Here are five tips for tips for improving your billing practices:
1. Strive to improve contracts by reviewing all of them to see who is out-of-line and what you can do about it. When going into payer negotiations, you have to show your service volume, the benefits of services and how low reimbursement rates and denials are costing your group money. Data must be used to show the payers where their system is wrong. Without data, you may as well not even walk through the door. Decision support reporting modules can provide payment analysis reports to give groups both credibility and leverage during payer negotiation sessions. A little work upfront can mean all the difference to your bottom line.
2. Try to negotiate unbundling with non-governmental carriers to offset all of the bundling that CMS has done. This can be very lucrative. In 2010, CMS started bundling services for exams that were performed together more than 75 percent of the time. For example, CT Abdomen and CT Pelvis were combined into one CPT code rather than two. Reimbursement was cut to 62 percent of what the values were previously. Many carriers adopted the same practice. By unbundling these bundled codes, you can increase your practice’s income.
3. Get the entire patient portion of the payment up front. If they can't pay, use a service to charge their credit card or checking account every month. The increasing popularity of HSAs and other high-deductible plans is being felt in practices everywhere. As more consumers become responsible for a larger portion of their bills, it is essential to collect payments at the time of service or set up an automated method of payment for the patient before they go in for their procedure. This can cause a drastic reduction in bad debt.
4. Understand your costs. Total cost of ownership (TCO) means that you know what all of your operational costs are and what each service costs you per patient. Having this knowledge will help you remove services that cost you money and don’t provide a return on investment (ROI). Do you know what services are important to your patients? Consider conducting a brief survey at check-in. You might find that some services you’re providing patients aren’t of value to their overall experience. This information can help you eliminate the low-hanging fruit and can also provide a benchmark for making additional cuts to services without creating dissatisfaction among your general patient population. Knowing your TCO can also help with vendors. If you understand your costs, then you can negotiate rates for volume, and everyone is a winner.
5. Review all partners' relative value units (RVUs) to ensure all employees and partners are bringing value to salary to the table. You can look at your revenue and work RVUs per full-time equivalent by location and use that information to adjust staffing based on volume and reimbursement. By comparing volumes and revenue across hospitals and imaging centers, your group will improve the profitability of underperforming locations. Decision support systems can be valuable tools, because they can quickly generate a chart, table or graph that answer any billing or productivity questions you need answered.
Taylor Moorehead is Zotec Partners’ Regional Partner, West Region, and corporate compliance officer. Moorehead oversees operations in California of more than $700 million in charge billing and more than $225 million in payments annually. He is a member of the Healthcare Billing Management Association, Healthcare Information Management Systems Society and Radiology Business Management Association.