As we contemplated the changes ahead in the healthcare system, we began to look more closely at our group’s financial data. The intent was to determine whether there were opportunities to reduce our overhead or increase our charge capture (revenue).
In talking with our administration, we recognized that historically there has been great variability in the involvement of the MDs in the billing process. That is probably not uncommon, but it’s not necessarily a good thing. The job of understanding the billing process and familiarizing ourselves with its many details seemed onerous, so we decided to take the long view. We broke the process into smaller pieces and started to look at it piece by piece.
The first area we addressed was one that tends to be neglected in some practices: management of insurance claim denials. The staff provided us with a detailed report of our denials by category for each month of the current calendar year and a month-to-month comparison with last year. While many of the denied claims stemmed from things that are not correctable by us, like registration errors in the hospital, we also found a substantial number were for medical necessity or lack of precertification—things directly under our control.
Information deficit hurts
The extent of the denials and the impact on our bottom line was a revelation. Our staff has historically insulated the doctors by dealing with the denials on their own, usually by tracking down the necessary clinical information from the health system or the physician’s office. That insulation comes at a price, however. When the physicians don’t know that they are not including the right information for coding, they don’t change their ways. To make a study reimbursable, the billing staff might spend hours tracking down clinical information that was available to the radiologist or technologists at the time the study was done but not included in their dictation.
Feedback leads to improvement
How are we improving our billing process so the documentation supports the charges we submit on claims? We now provide the physicians with copies of each of their studies that required the staff to obtain more information for billing. Along with the study comes a cover sheet telling the physician the outcome, be it a write-off or, ultimately, payment. This makes physicians aware of situations where their dictation or habits are costing them money on the back end, either in the form of additional office staff time or, worse, a claim that must be written off.
Another benefit of this feedback loop is that having the staff prepare the denial reports allows them to look for trends in denials and come up with ways to quickly address them. They plan to give us quarterly updates of trends in our denials and examples of omissions in our dictations that resulted in time-consuming research by staff.
Lastly, we are planning to hold annual physician training on coding updates to ensure the radiologists are helping the office to be as efficient as possible.
It’s too soon to tell if this new process is producing results but we’ll soon know if a positive trend is developing.
Dr. Woodcock is medical director for MRI at St. Joseph’s Hospital in Atlanta. He is also a member of the executive board of Atlanta Radiology Consultants and is the practice’s executive officer for finance. He may be reached at rjwatlrad@gmail.com.
