Two Important Questions: Is it Imaging or Radiology? Do you Prefer Outsourced Services or In-House Automation?

Presented by ADS and ADSRCM, leading sources of services and MedicsRIS for Radiology (or
Imaging)

The good news is, there are no wrong answers to the two questions above:

• After an exhaustive five-minute study, we found that “Radiology” and “imaging” are
  interchangeable (we’ll use both), and
• It’s about what works best for you, whether in-office automation or outsourced services
  and staffing

We hope you enjoy the read beginning with the finer points for radiology.

Automation’s Finer Points for Radiology

• Faxes. You have incoming referral faxes. That’s great because they represent new patients. 

But they need to be read, understood, and then affixed to patients’ records if they already exist, or to newly created records for new patients. You then need to proactively contact those patients to schedule their appointments, rather than waiting for them to call, which may or may not happen. 

So while faxes hold the promise of new patients, they can also tie up your staff with plenty of eyes-on/hands-on work. The good news is there’s AI-driven automation for this!

• WC/NF/PIP. In radiology, you likely encounter workers’ compensation (WC), no-fault (NF), and personal injury patients. Claims - especially for WC and NF - are complicated. They need to be submitted cleanly with specific documentation per your state’s requirements. 

You’ll want all of your claims, whether WC, NF, PIP, HCFA, or UB, to be submitted with a nearly 100% success rate on first attempt clearing house submissions. Not just submitted, but submitted for maximized reimbursements. 

• Attorneys. In imaging, besides having to manage patients and insurance payers, you almost assuredly have patients’ attorneys in the mix. 

You’ll want a built-in Patient Attorney Manager…an attorney database cleanly linking them to their clients (your patients), eliminating the mystery of which attorneys are handling cases for your patients.

And speaking of cases, you’ll want the Attorney Manager to be case-specific since patients with multiple/different accidents may have different attorneys for each one.  

A valuable bonus option is a secure, on-demand, self-serve Attorney Portal that empowers attorneys and their staff to access and review information independently, without disrupting your staff and generating zero additional revenue.  

You have enough to do administratively without having attorneys to deal with. There’s automation for this.

• Portals and Reports to Referrers. You depend greatly on keeping referrers connected and referring. To help ensure that, you’ll want (1) a referring physician portal, and (2) an ability to transmit finalized reports directly into any referrer’s EHR without requiring expensive HL7 interfaces. 
• PACS and Images for Patients. You’ll want connectivity with virtually any PACs, and then to eliminate CD burnings by making images digitally available to patients/caregivers for them to use and forward as needed.  
• Insurance Discovery. This is an interesting capability empowering you to discover insurance coverage for patients who have no insurance listed. A good insurance discovery option can reveal that as many as 30% of patients with no insurance have coverage.
• Advertising/Marketing. You might do advertising/marketing. If so, you’ll want to track how those campaigns are performing. This also includes new patients referred by existing patients. To do this correctly, you’ll need a customer relationship manager (CRM).

Stand-alone CRMs can be very expensive. But what if your management system or outsourced RCM service had a CRM utility embedded into it? Again, you’d eliminate another disparate system, vendor, and interfaces. 

Having a CRM utility embedded into your in-house RIS or outsourced service is possible.

Any or all of these “finer points” may apply to you. The good news is that there are “under one umbrella” solutions for all of these points, whether you prefer outsourced services and staffing from ADSRCM or in-house automation with MedicsRIS from ADS.

Driving Radiology Revenue and Protecting it in Advance

Revenue Types. You have two types of revenue concerns: (1) the revenue that needs to be protected in advance, and (2) maximizing the revenue you get. And both apply to each of your payer groups: insurance payers and patients.

Let’s delve into all of this, starting from before a claim is created. During scheduling, you'll want several actions to happen automatically, and you’ll also need access to other features.

Insurance. You’ll want both eligibility verifications and out-of-network (OON) alerts on scheduling. But here’s a word about each: (1) you’ll also want to batch-verify eligibilities through the scheduler a few times before arrivals to make sure nothing has changed, and (2) you don’t just want “dumb” OON alerts, you’ll want to see any of your other providers who might be in-network for the patient or expected procedures.

Prior authorizations (PA) are even more painstaking and time-consuming. You’ll want an ability to get PAs automatically when needed.

And then obviously, you’ll want to see any “red flag” appointments clearly highlighted on the scheduler, empowering you or your patients to take corrective actions as may be needed. 

With these kinds of proactive protections, you’ll be virtually assured that every patient arriving for their appointments has been preapproved insurance-wise, or that any OONs are handled per your financial policy on that.

Patients. As for patient balances, you’ll want to access a patient responsibility estimator as part of scheduling for a close approximation of what they’ll owe after insurance reimburses, assuming they have insurance. The estimator helps avoid surprises (No-Surprises), empowering you to prepare patients for what will be owed based on the expected procedures. Secondarily, the estimator should be accessible as patients leave and after the actual procedures have been performed, as procedures may differ from the expectations at the time of scheduling appointments.

You’ll want proactive, pre-submission alerts on claims likely to be denied by their payers, with denial reasons enabling you to edit them first and then submit. As a backup for any not pre-detected, you’ll want an easy-to-use denial manager for quickly editing and resubmitting those claims.  

Submitted Claims. Claims are submitted and you’re reasonably sure they’ll pass on first-time submissions, but you don’t want to “submit and forget.” You’ll want to view submitted claims in payers’ queues, in real-time, to ensure they’re being processed. This gives you the ability to nudge or question payers as to why particular claims may be lingering unnoticed.

The final step in insurance reimbursements involves automated EOB reconciliations, which keep your insurance A/R as accurate as possible by eliminating the need for hands-on line-by-line payment reconciliations.

Patient Payments. As patient responsibility balances are created (remember, there should be no surprises!), you’ll want an array of ways for them to pay. Interactive balance-due texting and/or emailable statements, both with payment mechanisms built in, should be available, as should a patient portal with online payments.

Of course, there should be an option for off-site paper statement production/fulfillment if wanted or needed.

Your imaging setting can take significant steps to protect itself in advance and effectively capture insurance and patients’ payments. ADSRCM and our team perform much of what has been described for clients, while ADS clients use the MedicsRIS as an in-house platform to do so.

Decision Support. Off again/on again clinical decision support (CDS) may be on again. If it happens, you’ll want to make sure referrers of Medicare patients for advanced imaging appointments (CTs, MRs, PETs, nuclear) have provided the necessary G-Codes confirming their decisions for ordering those studies. Without those G-Codes, you (not the referrer) will get denials on those claims. You’ll want alerts on those referrals if G-Codes are missing.

Workflow and Productivity for Radiology

You want fluidity and motion for your patients. You also want it for your workflow because bottlenecks and speed bumps drag your entire ecosystem of patients, providers, technicians, staff, and resources.

That’s why in addition to managing appointments, your scheduler must also be a workflow - and yes, a revenue generator - as well. 

Appointments. Scheduling appointments is what an appointment scheduler should do. But it should empower you to schedule intelligently by considering the staff/resources/diagnostic equipment that may be needed for a particular patient. By doing so, workflow and productivity would be dramatically improved with expensive imaging equipment maximized for revenue.

The scheduler should operate centrally or by place(s) of service if you have more than one location. You might want to see appointments based on a variety of parameters, such as by provider(s), tax ID(s), appointment type(s), payer(s), referral sources, appointments with issues (e.g., eligibility or prior authorizations needed), or any number of other elements.

Revenue. The scheduler should support verifications and out-of-network alerts during scheduling, and also enable batch verifications in advance. Additionally, it should provide access to a patient responsibility estimator during scheduling.  

You’ll want interactive appointment reminder texting, which helps eliminate no-shows by enabling patients to confirm or cancel through their texts. Either response type must be visible on each corresponding appointment. With that, you’d be able to quickly reschedule cancellations and move future appointments into open slots to keep your scheduling as tight as possible. 

Appointment Analytics. You’ll want appointment-related analytics. So, in addition to viewing appointments by any number of ways as noted above, you’ll also want to produce analytics on them. And you’ll like these scheduler analytics/reports/dashboards to be compilable by any number of user-defined parameters. 

The scheduler is, or should be, way more than a mechanism to schedule appointments. It must be a dynamic producer of efficiency and workflow, intelligence, and revenue (as is the MedicsPremier scheduler for ADS and ADSRCM clients).

Financial and Operational Analytics for Radiology

You’ll want four types of financial and operational analytics:

• historical, based on what happened in the past 
• current as to how things are going right now
• the future to see projections as to what will happen
• any combinations of these for from/to comparisons

Historical and current are apparent, but future? Yes, with access to predictive analytics, you can see how things will go, identify where corrections are needed to avoid issues, and enhance strengths to accentuate the positives.

You’ll want reports, KPIs, and dashboards to be user-defined with a virtually limitless number of parameters and filters. You should be able to drill into a particular field to see more details specific to the field. As defined by the user, they should be savable, then named, and scheduled to compile automatically as needed by the user. They must be exportable to Excel.

Outsourced RCM note. If you’re working with an outsourced RCM company, they should routinely compile reports for you and review them with you as well. But you’ll want 100% transparent access to all your data and be able to generate any report as well on demand, to the extent you want. 

A good RCM company would encourage you to see what they see and provide training on how to create reports.

The Dark and the Light. You can operate in the dark (“head in the sand”) financially and operationally, but if you’re a stakeholder in an imaging group, you know that’s not the way to go. Instead, you’d be in the light on strengths and weaknesses with dynamic, user-defined reports, analytics, KPIs, and dashboards presenting a picture of past, present, and future.

(ADSRCM and ADS support you being in the light as described.)

We hope you enjoyed the read. Contact us at 800-899-4237, Ext. 2264 or email info@adsc.com for more about outsourcing with ADSRCM, about using the MedicsRIS as an in-house platform from ADS, or about both if you’re unsure. We’ll help you drive revenue, productivity, and more, all in ways that work best for you!