Viewing revenue-cycle management as a function limited only to billing is shortsighted at best, and is more likely to be a mistake. Revenue-cycle management affects the entire practice, imaging center, and hospital radiology department, from a new patient’s first inquiry (whether made by telephone, through an online portal, or in person) to the receipt of payment for services rendered.
While procedures for executing revenue-cycle management might differ from one radiology entity to the next, savvy imaging providers recognize that a comprehensive, enterprise approach that extends beyond billing remains critical to the health of the bottom line. They also acknowledge that maximizing the effectiveness of revenue-cycle management necessitates that it be treated as a continual process, rather than as a periodically performed activity.
An Integrated Process
An integrated stance for revenue-cycle management bodes well for Carolina Regional Radiology, Fayetteville and Angier, North Carolina. Established in 1956 as Fayetteville X-Ray Associates, Carolina Regional Radiology has grown from a solo practice into one of the largest radiology practices in southeastern North Carolina, offering imaging and interventional services to hospitals, physician practices, imaging centers, mobile services, urgent-care centers, the armed forces, and individual patients throughout 10 counties. Its professional staff includes 21 board-certified radiologists, many of whom are fellowship-trained in subspecialties and some of whom hold certificates of added qualification in cardiovascular radiology, neuroradiology, and interventional radiology.
“For us, revenue-cycle management involves juggling not just billing, but multiple moving parts,” Sheryl Jordan, MD, explains. Her nonmedical duties at the practice include serving as its treasurer. This involves three categories: charges, adjustments, and payments.
The charges category includes, but is not limited to, electronic charge-capture interfaces, charge-capture auditing, charge master analysis, and adherence to state-mandated exam-appropriateness criteria to ensure correct coding. Examples of adjustments are electronic remittance/payment posting, payor audits for incorrect allowables, denial management, and self-pay strategies.
Under the practice’s umbrella of revenue-cycle management, corporate performance is measured against the current year’s budget, prior-year performance, and RBMA benchmarks. Assessment of the first two factors occurs monthly through a review of corporate financial reports generated in-house, as well as of custom billing reports generated by a Chattanooga, Tennessee, physician billing and practice-management company. Billing performance is compared with RBMA benchmarks bimonthly.
“We opted to keep the payor-contracting piece in-house because it falls within our own core competencies, but engaged a billing/practice-management company several years ago for billing services and analysis because its front- and back-end processes, as well as its technology, are a much better fit on that side,” Jordan explains.
“Despite our best efforts for more than 40 years, we were unable to achieve optimal results with in-house billing; in fact, we couldn’t even get close on a few of the must-achieve parameters,” she continues. “Our front-end/back-end manual processes and lack of technology hamstrung superb employees. Account underperformance, and hence corporate financial underperformance, was the sentinel, year after year.”
Communication between Carolina Regional Radiology and its billing company is constant, with claims transferred to and processed by the latter once each day and interim reports generated as needed. Claim denials and other information (work products) are also fed to the third-party company daily so that the root causes of problems (for example, coding errors) can be pinpointed quickly and errors subsequently can be rectified.
Carolina Regional Radiology’s approach to revenue-cycle management dictates stakeholder engagement in all of its aspects, as set forth in a practice model developed by Lawrence R. Muroff, MD, FACR. Muroff is clinical professor of radiology at the University of Florida and University of South Florida, and is president and CEO of Imaging Consultants, Inc, Tampa, Florida.
Adopted by Carolina Regional Radiology several years ago, the model espouses physician involvement in all facets of practice, as well as practice management