Q&A: Maximizing Profits in Hospital-based Radiology Practices, Part 2

September 21, 2011

In the second of a four-part series, Medical Management Professionals Inc.'s David Stone talks about the impact of HIPAA 5010 and ICD-10 on practices and how to prepare.

Increased regulations and higher fixed costs have many private radiology clinics across the U.S. choosing to affiliate with local hospitals or healthcare systems. Doing so, however, has raised new questions on the revenue side. Does it become easier or more difficult for a radiology practice to maximize its financial efficiency once it joins a larger healthcare system? What are the pitfalls - and the opportunities?

In this four-part series, representatives from Medical Management Professionals Inc., an Atlanta-based company that partners with ZirMed to provide billing services and revenue cycle management and practice management solutions to hospital-based doctors and practices, discuss operations, HIPAA 5010 and ICD-10 implementation, industry changes, and selection of an RCM partner.

Here, MMP’s David Stone talks HIPAA 5010 and ICD-10.

In your estimation, how significant will HIPAA 5010 be on hospital-based radiology practices?

The potential impact on physician cash flow can be huge if practices, billing system vendors, clearinghouses, and payers have not made and thoroughly tested the required changes.

Are there any ways radiology practices can use the advent of ICD-10 to their strategic advantage?

In the short-term, most practices are focused on just trying to figure out training and implementation. In the long-run, the practices with the best data will win. ICD-10 significantly increases the granularity of healthcare data. The strategic advantage of ICD-10 lies in being able to capture the data and use it to evaluate, and ultimately reduce, healthcare costs in the future in an Accountable Care Organization environment.

What is your advice for practices preparing for 5010 and ICD-10?

For 5010 the best advice is to test, test, and test! At this late stage of the game, practices must understand where they are in the testing process with their major payers and hospitals.

For ICD-10 the best advice is to start now. The deadline is closer than you think. Begin initial planning, analyzing current business processes, and developing an impact analysis. Do not believe that this change only affects your coders and that you do not need to be concerned about it, as this will affect all radiologists.

David Stone is the executive vice president of Medical Management Professionals, Inc. (MMP) and is responsible for creation and administration of MMP’s quality assurance plan. Mr. Stone graduated from Vanderbilt University with a degree in business administration. He is a member of Radiology Business Management Association, Medical Group Management Association, Tennessee Medical Group Management Association and Healthcare Billing and Management Association.

Click here for Q&A Part 1 on practice operations.