Informatics: The practice administrator's new BFF

As the regulatory and compliance burden on radiology practices grows, practice administrators increasingly are looking to IT to automate as much of the burden as possible.

This truth was evident both in session rooms and on the exhibit hall floor at the recent spring meeting of the Radiology Business Management Association, June 7–10, in Las Vegas, Nev.

In his session, “Laying the Groundwork for Risk Assumption,” Joseph Serio, CPA, MBA, FACMPE, described the extensive investment in IT that the 30-radiologist practice Radiology of Huntsville (ROH), Ala., has made in advance of participation in a regional-care organization (RCO). Beginning October 2016, Alabama Medicaid transitions from traditional fee for service to a system of RCOs, through which one in five Alabamians will receive care.

During the past ten years, the practice has created what is essentially a community PACS serving 35 facilities, enabling load balancing and subspecialized reads for all clients. It also established a single voice-recognition platform across all sites, an investment that resulted in huge efficiencies, Serio reports.

“Standardizing templates has helped us in a few areas,” he notes. “With retroperitoneal ultrasound, for instance, you have to name the specific organ systems and if you don’t do that, it goes from a full study to a limited one. I realized a few years back that ROH was losing $55,000 a year because the radiologists weren’t mentioning the specific organ systems that need to be reviewed.”

Boosting billing

An investment in new billing software resulted in vastly improved data-mining capabilities, including the ability to analyze RVU work components by site, rotation and individual radiologist, and set work RVU goals by rotation.

“The software helps us get the information we need for risk assumption, and it also lets me look at utilization by payor,” he says, estimating that an RVU in radiology is an average of $50, and an increase of just 10 a day adds up to $100,000 per year per radiologist.

ROH invests approximately 3% per year in IT, Serio says, an investment that has enabled the practice to bring a new site on in short order. “The slowest part of us providing a new service is getting the radiologists credentialed,” he notes.

Serio’s advice to practices just beginning to build their IT infrastructure is to “go to the cloud,” he says, explaining that the software-as-a-service approach it currently takes with IT partner FINAO, a local regional IT provider, is a tenth of the cost of buying the equipment outright.

Negotiations between the state and the RCOs begin later this year. Serio and ROH president G. Scott Tucker, MD, Ala., wrote about the practice’s preparation for risk assumption in the August/September issue of Radiology Business Journal.

Automating eligibility

On the exhibit floor, eRad showcased the ability of its eRad RIS to optimize time-of-service collections by providing automated online eligibility checking. “Any good RIS should have eligibility built into it,” says Seth Koeppel, MBA, senior vice president of sales, eRad, RadNet Technology Solutions. “Just because you have a little card, doesn’t mean you have insurance.”

As the IT arm of RadNet, the nation’s largest network of imaging centers, eRad leadership is acutely aware of the need for practice efficiency. “Our inventory is our time slot,” Koeppel says. “If we book it to someone who doesn’t have insurance, we lose inventory. It needs to be checked at the time of scheduling.”

The cloud-based eligibility API is tightly integrated with the eRad RIS so that with the push of a button, users get confirmation of insurance, deductibles, amount satisfied, co-pay, co-insurance and current address, enabling the site to calculate the balance owed and automate address and other information updates.

Being able to do this real-time, electronically, in an automated fashion with zero human intervention, has resulted in “exponential” growth in RadNet’s time-of-service payments, Koeppel reports, with similar results in eRad’s commercial client base. One Florida client was able to reduce the number of FTEs assigned to this task by more than half.

Business intelligence

Medical billing and management company, Management Services Network (MSN), Columbus, Ga., introduced a new business intelligence solution called advyze BI that incorporates all data the practice is generating, developed in conjunction with partner Advanced BI, specializing in revenue cycle management, electronic data exchange (EDI) and health IT.

Nicole Newsom, MHA, VP of product management, explains that MSN set out several years ago to develop a billing intelligence solution that would generate key performance indicators, dashboards and billing analytics, but came to the realization that it wasn’t enough.

“The radiology space had changed, the needs had changed,” Newsom explains. “No longer could we answer the questions arising with just one system.”

The advyzeBI system interfaces with billing, PACS and RIS to provide insight into a practice’s pressing questions, such as whether peer review cases correlate with volume and why a physician’s TAT changes based on which workstation he or she is reading from and the factors that are responsible.

The solution is web-based and browser agnostic, providing data real-time that is accessible on any device. “This is a pioneer trail-blazing moment for radiology,” says Newsom. “If you wait until you need data, you may be too late to get there.”

Getting paid

Pre-authorization also got a dose of automation from a company new to radiology, Fore Support Services, El Paso, Tex. The company comes into a practice and analyzes the payor mix and denials history and uses an HL-7 feed to retrieve data from the RIS and return the feedback from the payor, explains Mohammed Mansoor Ahmed, president and CEO.

The system is designed to check for authorizations every 15 minutes and the resulting information—including total estimated cost, remaining deductibles, co-insurance status—is pre-populated into the RIS.

“Eighty percent of the [pre-authorization] work is eliminated, because most are authorized,” Ahmed explains.

Rick Lafayette, COO, Premier Radiology, a Nashville, Tenn.-based practice with interests in nine imaging centers that served as a beta site, explains that the system can also prepopulate ABNs for every patient, which has been helpful in collections.