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Reinventing radiology reimbursement


, : Reinventing radiology reimbursement. Radiology Management 27(2): 36-44, 46; Quiz 47-9

Lee Memorial Health System (LMHS), located in southwest Florida, consists of 5 hospitals, a home health agency, a skilled nursing facility, multiple outpatient centers, walk-in medical centers, and primary care physician offices. LMHS annually performs more than 300,000 imaging procedures with gross imaging revenues exceeding dollar 350 million. In fall 2002, LMHS received the results of an independent audit of its IR coding. The overall IR coding error rate was determined to be 84.5%. The projected net financial impact of these errors was an annual reimbursement loss of dollar 182,000. To address the issues of coding errors and reimbursement loss, LMHS implemented its clinical reimbursementspecialist (CRS) system in October 2003, as an extension of financial services' reimbursement division. LMHS began with CRSs in 3 service lines: emergency department, cardiac catheterization, and radiology. These 3 CRSs coordinate all facets of their respective areas' chargemaster, patient charges, coding, and reimbursement functions while serving as a resident coding expert within their clinical areas. The radiology reimbursement specialist (RRS) combines an experienced radiologic technologist, interventional technologist, medical records coder, financial auditor, reimbursement specialist, and biller into a single position. The RRS's radiology experience and technologist knowledge are key assets to resolving coding conflicts and handling complex interventional coding. In addition, performing a daily charge audit and an active code review are essential if an organization is to eliminate coding errors. One of the inherent effects of eliminating coding errors is the capturing of additional RVUs and units of service. During its first year, based on account level detail, the RRS system increased radiology productivity through the additional capture of just more than 3,000 RVUs and 1,000 additional units of service. In addition, the physicians appreciate having someone who "keeps up with all the coding changes" and looks out for the charges. By assisting a few physicians' staff with coding questions, providing coding updates, and allowing them to sit in on educational sessions, at least 2 physicians have transferred some their volume to LMHS from a competitor. The provision of a "clean account," without coding errors, allows the biller to avoid the rework and billing delays caused by coding issues. During the first quarter of the RRS system, the billers referred an average of 9 accounts per day for coding resolution. During the fourth quarter of the system, these referrals were reduced to less than one per day. Prior to the RRS system, resolving these issues took an average of 4 business days. Now the conflicts are resolved within 24 hours.

US$29.90

PMID: 15898580


Other references

Sepp, V., 1963: Results of the treatment of strepto-coccal mastitis in cows with antibiotics and sul-phanilamides in tubes.. Streptomycin-sulphadimezine emulsions were found to be very effective in the treatment of acute catarrhal and fibrinal mastitis, being slightly superior to a oxytetracycline emulsion. Similar results were obtained in the treatment of latent mastit...

Anderson F.E., 1979: How sedimentation patterns may be affected by extreme water temperatures on a Northeastern coastal intertidal zone. Northeastern Geology 1: 122-131

Vinokurov, S.I., 1934: Vitamine C contents of Mexican tomatoes.. From tests on guineapigs it was estimated that Mexican tomatoes contained 50 " units " of vitamin C per kg. an amount similar to that contained in grapes and red bilberries. (From summary).

Anonymous, 1950: Mechanism of Relief in Rheumatoid Arthritis. British Medical Journal 2(4682): 768-769

Morgan M.E., 1970: Microbial flavor defects in dairy products and methods for their simulation part 2 fruity flavor. Journal of Dairy Science 53(3): 273-275

Rinaldi, L., 1969: Prime osservazioni sull' azione di ormone follicolare e talidomide sulle proteine seriche in Columba Livia Gm. Rclomb. Sci. Lett. (Ser. B): 103-114

Munares-García, O.; Gómez-Guizado, G., 2016: Réplica: el punto de corte de la hemoglobina para definir anemia materna en la altura no debe ser corregido. Revista Peruana de Medicina Experimental Y Salud Publica 32(1): 199-199

Brewer, E.N., 1979: Repair of radiation-induced DNA double-strand breaks in isolated nuclei of Physarum polycephalum. Radiation Research 79(2): 368-376

Nagel, D.B.teman, W.; Fox, J.; Houston, D.; Jarratt, J.; Graves, B.W.llace, B., 1988: Commercial production of watermelons in Mississippi. Publication Cooperative Extension Service Mississippi State University: 88 (1533)

Guilloton, L.; Pegat, A.; Defrance, J.; Quesnel, L.; Barral, G.; Drouet, A., 2017: Neonatal pancytopenia in a child, born after maternal exposure to natalizumab throughout pregnancy. Natalizumab is a monoclonal antibody indicated for the treatment of patients with relapsing-remitting multiple sclerosis. Its use is prohibited during pregnancy. However, natalizumab exposures throughout the gestation period or during the third tr...