Radiology services historically have been a profitable, diagnostic foundation of the healthcare delivery system. But as imaging volume and costs have skyrocketed, healthcare purchasers seeking to reduce healthcare spending have increasingly challenged the necessity and cost of imaging services.
As a result, radiology has become a target for reimbursement cuts, including the Obama administration's proposed cuts to save Medicare an estimated $820 million in imaging costs across a 10-year period starting in 2013. In addition, the shift from fee-for-service to value-based pricing, emergence of meaningful use criteria and accountable care may combine to further erode the profitability of many radiology groups.
Radiology providers need to take advantage of next generation, cloud-based accounts receivable (AR) financial management platform technology to reduce inefficiencies and costs and to maximize profitability.
Evolving Technology, Upfront Advantage
Process improvements associated with back-office activities such as claims processing, eligibility checking, payment processing, and coding can be significantly improved using revenue cycle management technology to automate workflow, reduce costs and increase revenue. A state-of-the-art AR financial management platform instantly captures and stores detail about each transaction starting at the point of the patient visit.
To help maximize profitability, these systems continually apply updated rules and checks at the front end of the billing process to immediately identify errors, determine trends in denials and help generate a clean claim that will have the highest probability of getting reimbursed by payers on the first submission. Let's take a look at how such a platform can help streamline major back office functions.
Real-Time Information Access and Sharing
One of the primary functions of the back office is processing claims. Getting the right information required for a clean claim from the start can dramatically accelerate cash flow and improve revenue.
Using standard Internet interoperability and healthcare security protocols, next-generation financial management platforms are able to share communication, information and services with disparate and distributed systems through use of cloud-based web services. This interoperability enables a "coupling" of systems regardless of source, operating system or programming language.
Cloud-based AR financial management platforms capture and validate all necessary information, from one or more RIS, PACS, or CPOE systems, and communicate requisite information back to these systems in a two-way digital "conversation." This framework reduces workload on billing staff by reducing duplicate data entry and allowing more self-service functionality. It also increases cash flow by automating error processing and speeding reimbursement and patient payment.
While traditional systems have achieved some degree of communication, they require hard-coded static interfaces that are difficult to maintain or revise. Further, traditional systems cannot communicate in real time or be easily altered to integrate new information-sharing systems.
Computer Assisted Coding
Many radiology providers lose significant revenue because of inaccurate coding. A powerful tool that providers can leverage to improve their efficiency and decrease errors is computer-assisted coding (CAC)--a cutting-edge capability that automatically derives medical codes from within clinical documentation.
A number of companies have created natural language processing algorithms to assist radiologists in coding reports. The use of CAC can increase productivity, ensure coding consistency, improve cash flow, and help radiology groups prepare for ICD-10.
It has been estimated that CAC software may increase coder productivity by as much as 20% to 35%. Use of CAC can result in fewer miscoded, rejected and denied claims as well as more accurate payments. Financial management platforms can be leveraged in support of CAC.
Real-Time Error Processing
Next-generation AR financial management platforms integrate real-time claim validation software that provides detailed checks for HIPAA compliance, thousands of embedded payer clearinghouse rules, validity of all CPT, HCPCS, and ICD codes, medical necessity, and age and gender-specific procedures.
With new electronic transaction requirements, ever-changing payer edits and regulatory requirements, and evolving services and technologies, traditional billing systems are difficult to maintain. Falling behind in mandatory system updates results in slower or improper reimbursement and reduced cash flow.
Next-generation AR financial management platforms use real-time cloud delivery to constantly push changes in standards, software updates and payer edits quickly with no disruption for providers. This seamless agility was unheard of in the days of traditional billing systems, which typically offered infrequent updates that had to be installed and managed by the provider.
With a financial management platform that is up to date and communicating in real time with all relevant systems wherever they reside in the healthcare continuum, automated error processing can be ensured from the start, running the same payer rules and edits as the billing department. Advanced workflow logic informs staff of any problems early, so that clean claims sail through the system, reducing delays and increasing cash collections.
New web service technologies provide a standard means of connecting different software applications, running on a variety of platforms via a secure Internet protocol. This opens the door for real-time data exchanges between software applications being used at hospitals, imaging centers and payers, thereby ensuring proper charges, compliance and reimbursement.
Future Proof Billing and Accounts Receivable
It is impossible to anticipate all the changes that will come down the pike, but it is clear that the needs for interoperability and interconnectedness will only increase. Stage II Meaningful Use is only one example, and who's to say how many stages and requirements there ultimately will be for this one initiative?
Cloud-based AR financial management platforms were developed with the future in mind. Web services allow providers in the healthcare continuum to deliver and share content and provide a means to respond to changes and specific needs without costly and inflexible hard coding, or productivity-killing workarounds. They've proven their value today and will become indispensable in the future of radiology, whatever that future might bring.
David Byrd is vice president of radiology market development, XIFIN Inc., San Diego, Calif. For more information: email@example.com.