Insurance filter sorts work list for teleradiologists

July 1, 2008

A system presented at the SIIM meeting is able to develop work lists based on a patient's insurance and a radiologist's credentialing status, which are important considerations as more studies are interpreted away from central offices and facilities try to maximize reimbursement.

A system presented at the SIIM meeting is able to develop work lists based on a patient's insurance and a radiologist's credentialing status, which are important considerations as more studies are interpreted away from central offices and facilities try to maximize reimbursement.

The original inspiration for the system was the need to keep studies for Medicare and Medicaid patients off work lists used by radiologists based outside of the U.S. The Centers for Medicare and Medicaid Services does not permit payment for interpretations performed on non-U.S. soil, although most private payers do.

Few, if any, RIS or PACS today have the ability to filter work lists based on insurance status, according to coauthors Drs. David S. Hirschorn and Leonard Lempert, both of Staten Island University Hospital.

Their solution, described in a poster presentation, was to develop an algorithm that removes CMS studies from a work list developed for an overseas teleradiologist reading night studies for the hospital. Elements of the algorithm then filter out cases from the overseas teleradiologist's work list based on whether CMS will pay for them, whether the radiologist is credentialed for the payers, and whether it is an emergency case.

Later, the same system was adapted to steer nonemergency cases toward radiologists who are credentialed by the payers that are associated with the cases. The system increases the likelihood of payment for all claims from the department, the authors said.

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