Revenue Management techniques for your Radiology Practice A very important aspect of the health care system is the radiology practice. With constantly changing rules and high-deductible plans offered by insurance payers, radiology practice needs to have an aggressive management system along with a steady structure for increasing its revenues; this is absolutely essential for the survival of the practice. Also, the need is to streamline operations and bind with technology. Here's how the radiology practice can anticipate its revenues: 1. Optimize collections through patient portal: A secured webpage to make payments must be offered via the physician's or the healthcare center's website, which allows the patient to update/edit his demographic details, and view and pay the outstanding amount. The changes are automatically updated, in a short while, on the patient's profile. This eliminates the need for additional staff, improves access for the center and the patient, thereby improving communication between the two parties. 2. Outsourcing: As every dollar counts, many radiology practices are turning towards outsourcing their billing and coding requirements. These outsourcing agencies aid in decreasing denials, lower the operating costs of the practice, and tend to improve the organization's outcome by reliable and timely reimbursement, and by providing profitable services. The outsourcing company ensures that each charge is captured, and decreases the practices' cost on employees and other costs related to technology, which would have been otherwise necessary. 3. Radiology Benefit Managers (RBMs): Payer contracting necessitates radiology groups to work with RBMs. Many private payers are utilizing the services of RBMs to manage the radiology practice along with providing services through prior authorization. This is due to that fact that RBMs are usually experts on payer’s trends, are knowledgeable on payer’s rules and guidelines, ensure proper coding, and consider a check for preauthorization or reauthorization. They tend to lower costs as well. 4. Coding: Incomplete or inaccurate coding leads to a loss in revenues. Billing software comes to the rescue here. It tends to minimize denials with fewer errors committed , and runs the code through an editing function to see if it passes; creating the window for reimbursements to open within a 45-60 day framework. Radiology practice must make sure the coders are certified, and trained enough to code effectively. 5. Business intelligence tools: In the previous years, reports took rather long to be generated with key information not reaching the appropriate person at the appropriate time. Hence, decision-support software systems have been introduced and must be used by radiology practitioners and their billers and coders for effective administration. These systems can identify and administer changes in modalities,
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carriers and quantities. These systems aid in the understanding of benchmarks, key performance indicators, and tracking staff productivity which is essential to the functioning of the practice. 6. Improving charge capture: All bills must be paid for and all reimbursements must be collected, hence it is essential for the radiology practice to capture all charges. Implementation of such systems will ensure all documentation of all procedures, devising of variance lists, conducting apt coding, and recording of audits along with charges by procedures. 7. Claims: Ensure accuracy of claims; with the claims submission process being as proficient as possible. For this, include system scrub codes based on the insurance payers' regulations and Dx rules in your arrangement. Accuracy of registration and billing details is imperative with the apt diagnosis codes and CPT Service codes while charge posting. This will speed up the reimbursement process. Claim postings must also be speedy and error free. 8. Quality: Ensure all correct data is collected, transferred, and is error free for quick reimbursements. Also ensure that your revenue cycle management firm (in-house or outsourced) pulls and audits (front and back-end) 5% of your daily claims. 9. A/R Management: Assign a staff who constantly analyses the accounts information and ensures a review schedule in place at all times. This is essential for keeping a tab on the payer contracts and compliances. Also, the A/R team must compare year-to-date totals as against the previous years and cautiously follow A/Rs that are more than 60 days. 10. Collection capability: The focus of many practices is shifting to outstanding balances; mainly due to high deductibles and self-pay options for patients. Hence, the billing and coding team must have the appropriate software and processes for appealing low paid claims, tracking denials, carrying out reporting, and regaining reimbursements. Leverage technology, ensure expertise in medical billing, organize data and pursue small balances, vigilantly augmenting the revenue cycle management approach.
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