Practice Highlights: Established in 1987. High volume practice in high-density urban area with over a hundred thousand patients through the doors, annually. Interventional Radiology, leveraging CT imaging, enables precise guidance of needle placement in support biopsies, as well as injections to specific nerve bundles in spine and joints in support of pain management.
Company Size: 7 Physicians / 80 FTEs
Specialties Served: Radiology: X-Ray, Nuclear Medicine, PET/CT, CT, MRI, Ultrasound, Interventional Radiology inclusive of biopsies and pain management
Radiology is both high-volume and multi-faceted at University Diagnostic Medical Imaging (UDMI) in the Bronx NY, with hundreds of patients moving through the practice for one or more radiological procedures on any given day.
The Administrator behind UDMI’s operation is Robert Klein who points out the keys to UDMI’s successful and profitable operation are (1) consistently high patient satisfaction ratings and (2) a unique, sophisticated revenue management
When Mr. Klein joined the practice in 2005, UDMI was just transitioning from their Medics II system which had been in use successfully since 1995, to the MedicsRIS and MedicsPM systems, all of which are produced by Advanced Data Systems (ADS).
Mr. Klein was able to help the practice weave together a unique and highly customized set of tools for scheduling, workflow and revenue management. These tools are all built around the MedicsPM and MedicsRIS with capabilities such as comprehensive radiology EDI and claims management, financial and management reports, as well as the scheduler and workflow.
“It would have made no sense to get a RIS from one vendor and a PM / billing system from another when a company like ADS does it all. With ADS we acquired a whole and complete radiology solution on which to run the practice,” said Mr. Klein.
UDMI also went on to implement ADS’ MedicsEHR for Radiology. More information on that appears further in profile.
Medics Workflow: Tracking & Managing Each Stage of the Patient Visit Using the MedicsRIS Scheduler, a UDMI staff member assigns an appointment time to the patient and reserves the proper diagnostic equipment room for each procedure. Mr. Klein says that the real magic happens on the day of the appointment within the MedicsRIS Workflow capability.
Workflow manages and tracks the patient from the moment of check-in. Insurance verification had either already been obtained in advance using the system’s batch EDI verification capability which can also be done “on the spot” for any same-day patients. Workflow then follows the patient’s progress through the facility, since one appointment can involve multiple resources and Mr. Klein noted, “A patient may come in for multiple exams on the same day.
Our challenge is to efficiently coordinate each patient visit across different departments to ensure the patient is seen in the proper sequence, and moves through their appointment without delays.
Using Workflow, UDMI staff can see exactly where the patient is in their visit…if they are in an imaging room, if the image has been read by a radiologist, if the reading has been transcribed, if the patient is in consultation with a specific radiologist, etc. All stages of the visit are tracked, time stamped, color coded and captured by the MedicsRIS system as the patient moves through their appointment.
Workflow is able to collect all this information by communicating via HL7 with each piece of diagnostic imaging equipment through a PACS control center. For example, MedicsRIS Workflow sends an HL7 message to the PACS system telling the control center to put Patient Doe in the queue for X-Ray machine 2. When the image has been captured for Patient Doe, a message is sent back to MedicsRIS telling Workflow exactly when Patient Doe left X-Ray-2 room, and that Patient Doe has moved to the next stage of the visit.
Downstream, a radiologist uses the Workflow Physician Desktop to determine the next case to be read. “For patients requiring multiple procedures, we often need to ensure that one image is read before another. We use Workflow to guide our radiologists through the proper sequence for each patient exam.
Workflow controls the lifecycle of the readings by the radiologists,” Mr. Klein said.The reading process includes a case review and all previous information relevant to that case.
A digital file is created which the radiologist reviews and digitally approves. At this point using MedicsConnect - a capability built into MedicsRIS - the report can be electronically transmitted to the referring physician for uploading directly into the referring physician’s EHR.
When the process delivers a radiologist-signed report, Workflow hands off its data to the MedicsPremier billing platform.
“Some radiology practices order their RIS procedures using abstract codes, and then have their billing team reconcile those custom codes to the CPTs,” said Mr. Klein. He added, “At UDMI, when an exam is ordered, that procedure is identified by the actual CPT code. By the time the patient’s visit gets to billing, we know exactly what exams have been performed and the proper CPTs because the MedicsRIS Workflow system collected and carried all that data down the line with each patient’s visit. At the end of the visit, Workflow sends the CPT codes and the physician report to MedicsPM for billing” MedicsPM properly formats and submits each claim to the respective carriers. “The system supports multiple claim output files depending on the interchange used. For us, one of the real values of ADS is that they stay on top of all the governmental and carrier changes so we are able to send consistently clean claims,” said Mr. Klein.
Revenue management, reporting and the ability to manage patient visit data through one integrated system is, according to Mr. Klein, “one of the strongest reasons we stay with ADS.” At UDMI, the patient visit starts and ends fairly quickly as explained by Mr. Klein, “Typically a patient is in and out of our facility within an hour. It’s the other aspects of the business such as managing patient authorizations, billing, collecting, and business analysis that typically takes time at a radiology practice. Using the Medics Suite, that is not the case with UDMI.”
When it comes to managing the business, it is the flexibility of the Medics systems that has made a loyal fan of Mr. Klein.
“I’m of a programming mind. I like to work with software that enables me to customize it to give me what I need to operate our business. The Medics systems from ADS are architected to do exactly that. I can manipulate tables and use fields and structures in ways others may not want. Other radiology clients of ADS may use their Medics systems in completely different ways that work for them. That’s the beauty of the Medics Suite for radiology. It is so flexible, I sometimes feel I am able to do things with the system that no one else has thought of!” Mr. Klein said.
Accounts receivable is an example of the system’s powerful customization. Mr. Klein noted, “We have created a complex schema out of accounts receivable codes so that we can track the status of each claim by carrier and in some cases, by carrier sub-group. This enables us to compile reports telling us where to most critically apply follow-up resources.”
Additionally, UDMI is tracking discrete carrier variables such as deductibles, co-pays and procedures requiring pre-certifications. Mr. Klein tracks how each carrier is paid by CPT code and by provider. He also uses this data to trend each carrier’s payment performance. Armed with this statistical information, Mr. Klein uses it when negotiating with the carriers.
Another example of how Mr. Klein has used Medics system customization flexibility is in a unique patient payment system that he created whereby the front desk team at UDMI can actually advise each patient on the day of their visit as to the amount for which he or she will be responsible.
“I’ve taken the tools that Medics has provided and used them to support revenue collections. Prior to a patient’s appointment, we do our homework on how this patient’s exam will be treated by their carrier. Our front desk team can access this information during check-in. For example, they can see that the patient has a $20 co-pay, 20 percent co-insurance on the procedures to be performed, and has an annual deductible on which $150 remains. In that scenario, the patient can be advised they will owe $360 for that particular visit. That is powerful and really puts us in a position of strength right up front.” As mentioned earlier, UDMI had also adopted the MedicsEHR for Radiology, completing the circle of solutions for managing the practice and managing patient clinical data.
Mr. Klein boils down the reasons he is committed to ADS to two main points:
“ADS is a company where the chief executive and founder is still deeply involved in its day-to-day operations. The company’s stability and reliability is without parallel. You just don’t see a privately owned company such as ADS with its history in this industry. Because of that we feel confident the product will continue to grow and perform, and that the company will remain highly responsive to their clients’ needs.”
“ADS has created in the Medics Suite a unified solution that is highly flexible yet supportable. UDMI has been able to create a world of custom strategies for capturing and reporting on the data we need. Our Medics systems have remained stable through every new product update, and there have been many over the years UDMI has been with ADS. That is an ADS hallmark, and how ADS thinks; they are sensitive to things that mean the most to clients,” said Mr. Klein. Mr. Klein closed by saying, “I would not hesitate to recommend ADS and their Medics Suite for Radiology to radiology practices of any size.”
Marc Prager, MD
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