Process Automation: The Key to Improved Financial Performance

The high procedural volumes associated with radiology provide both a challenge and an opportunity. The old days of handling paper persist to varying degrees, but organizations investing in technology to automate common processes have demonstrated an ability to improve productivity and profitability while decreasing associated costs. This is especially important as reimbursements continue a downward trend and payors continue to impose additional administrative requirements. Automation has been highly successful in a number of key process areas. What are they, and why are they important? Data Acquisition and Reconciliation Radiology was one of the more progressive medical specialties in terms of downloading demographic information, although virtually every group will confirm that a certain portion of its business is still derived from paper documentation. Changes, however, have been appreciated in several key areas, including electronic report acquisition, optical character recognition/scanning, and reconciliation. Recommended compliance practices call for coding from radiology reports, rather than from hospital charge documentation. Voice-activated dictation has facilitated the acquisition of digital report documentation, with the result that charge and coding information files are brought into the billing system within minutes. In contrast, the previous scenario of sorting large volumes of paper reports for coding and charge entry could literally take days—and several staff members. Even when radiology reports are not available in digital formats, they can be scanned by intelligent software capable of sorting files and matching them to demographic information by patient. While scanning is less efficient than digital data acquisition, it greatly streamlines processes when electronic report versions are not available. Again, this process reduces the number of staff members involved in data sorting, matching, and entering information for billing. Missing charges are a source of concern for any hospital-based group, and paper-based processes for matching demographics and radiology reports are cumbersome, as well as ineffective. Before technology was used, this meant retaining stacks of paper order/demographic forms and sorting through them daily as new radiology reports were received—or at best, attempting to enter reports into the system and matching them to demographic files based on several match criteria. As reconciliation processes were automated, they were also enhanced, in terms of the ability to validate data capture with several source documents, including demographic files, department log sheets, and/or information from the radiology information system or PACS. Some of the greatest billing-efficiency gains have occurred at the data-acquisition phase, with measurable results of reductions in staffing improvement in the timeliness of claims preparation and submission, and reductions in lost charges. Coding and Charge Entry Accurate coding is at the core of the billing process, especially in terms of ensuring that each procedure dictated by the radiologists is adequately documented and submitted as a charge. Dramatic changes have occurred in the automation of coding and charge-entry processes. Technology has facilitated the coding process by reading a report and assigning appropriate procedure and diagnosis codes for review. Organizations have been able to leverage the efforts and experience of their coders by moving them to a position of reviewing/approving simpler procedures coded by the technology and allowing them more time for the more complex procedures requiring human intervention to assign codes. The ability to use technology for sorting also has enabled larger organizations to sort and assign work by modality, with the result that coders can specialize in certain areas and complete coding assignments more efficiently when they are not moving constantly among widely varying modalities. In most of the advanced billing systems, demographic information and reports are displayed side by side. Codes are simply entered into the charge screen during the coding process and the claim is released. In contrast, older processes required passing stacks of paper from the coding department to charge entry and could take multiple days to complete. Claims Editing and Electronic Submission Automated claims-editing procedures have been credited with improving cash flow and reducing the number of insurance claims requiring follow-up action. Editing (or scrubbing) software scans data elements and isolates missing or incorrect information into an exceptions report for review and correction. The ability to submit a clean claim improves the potential for that claim to be paid on the first pass; the result is that the claim can be paid within days, if filed electronically. In contrast, a claim submitted with errors will be denied or rejected, requiring additional work and slowing payment. In fact, paper claims can take several weeks to process, again slowing cash flow and increasing staff workloads. Electronic claims submissions have not only become common, but are mandated by Medicare, unless the practice meets a narrow range of criteria allowing an exception from this requirement. While HIPAA presented numerous challenges in terms of implementation, one of its goals was to streamline electronic processes related to claims submission and payment, including mandated methods for determining claim status. One of the greatest benefits of HIPAA lies in more rapid payment patterns, supported by simplified verification processes to identify and correct rejected claims quickly. Other Key Developments Document scanning and management: One of the greatest areas of inefficiency in the billing process lies in insurance follow-up action. Old processes involved filing coded radiology reports, explanation-of-benefits forms, orders/authorizations, and insurance correspondence in various combinations of file folders. When a claim was denied for payment, a staff member identified documentation required for correction and/or appeal, dug through file folders, photocopied the required information, and then refiled the paperwork. Scanned documents enable the employee to find information on the workstation, print it, and submit it, again reducing the entire process from minutes (or hours) to seconds. Online payment options: The collection of patient payments can also represent an inefficient process area. Enabling patients to make payments online facilitates the process of payment and reduces the number of staff members required to complete it. Electronic payment posting: Another HIPAA-enabled procedure involves the transmission of payments in a standard file that allows automated posting directly into the billing system. Conclusion Radiology billing and collections processes have greatly benefited from the application of automation similar to that developed for the banking and credit-card industries. As practices face the dual challenges of decreased payments and increasing overhead, there is intense scrutiny of the costs and efficiency of the billing operation. The automation of key processes has enabled leading organizations not only to remain competitive, but actually to improve the effectiveness of their work, as well as practice profitability.