Governance, Mission, Growth

Partnership Offers RIS-Integrated Business Services
Barriers to adoption of information technology, by practice size
“How To” Manual Outlines Digital Mammography Transition
Mastering the Revenue Cycle

Partnership Offers RIS-Integrated Business Services

A new partnership between Agfa HealthCare, Greenville, SC, and Sonix HealthCare Solutions (SHS), Hauppauge, NY, will allow Agfa’s imaging center customers to purchase the complete line of SHS financial and business consulting services in the United States. The agreement integrates SHS’ revenue-cycle management services with Agfa’s Impax RIS for Imaging Centers, which includes scheduling, image capture, and reporting features.

Mike Butler, CEO of Pinnacle Orthopedics & Sports Medicine Specialists LLC, Marietta, Ga, who selected the Agfa-SHS integrated package, says, “We needed to streamline communication between our nine offices, and between pods within offices. We needed players to come in who understood larger, more complicated systems like the ones we have. We wanted the level of expertise and technology brought by bigger players in the marketplace.”

The Agfa-SHS package handles payor contracting, front-end scheduling, compliance, practice management, billing and collection, managed care consulting, and IT services. Butler’s group is currently migrating its legacy stand-alone PACS, which it used for 5 years, to Agfa’s system in order to take full advantage of the integrated services. “We have weekly project calls with a team of engineers that have been working on the equipment and the data migration from the old PACS,” he says.

Owing to both the data migration factor and the telecommunications aspect of the project, Butler expects installation to take about 90 days. After that, he anticipates achieving return on investment in 2 years or less.

“We’re looking forward to improved efficiency of workflow, elimination of downtime related to the PACS, and coordination with our practice management system,” he notes. “The other additional benefit, which is an unforeseen financial gain, will be the ability of our physicians to access data at any point, anywhere in the world. We don’t have that capability with our current vendor.”

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“How To” Manual Outlines Digital Mammography Transition

To help radiologists make the move from analog to digital mammography, hcPro Inc, Marblehead, Mass, offers transition advice in its guide, “Digital Mammography: A How-To Manual for Seamless Implementation.” Authors Valerie Andolina, RT, and Theresa Wade, MPH, ACMPE, provide a big-picture perspective based on their experiences at the Elizabeth Wende Breast Clinic, Rochester, NY, as imaging technology manager and business manager, respectively. The guide explores such issues as timing, economics, technology, support, training, and workflow changes.

Since the September 2005 release of the Digital Mammographic Imaging Screening Trial (DMIST) results, which showed that digital mammography offers equivalent image quality and superior cancer detection compared with analog, facilities across the country have grappled with issues including system challenges, new terminology, and staff learning curves as they make the transition. The manual’s six chapters explore the following issues:

  • “Going digital” looks at DMIST and the pros and cons of digital mammography;
  • “Preparing for the conversion” explores the cost of digital technology, consumables, service issues, staffing issues, and reimbursement;
  • “Making the change and choosing your equipment” examines how to determine your facility’s needs, make purchasing decisions, choose between CR and DR, manage image storage, and think about CAD and RFPs;
  • Read All About It!
    For more on the state of digital mammography, don’t miss “Specialty Report: The Future of Breast Imaging.”
  • “Helping the staff make the conversion” focuses on handling resistance to change, straddling two technologies, training staff, easing the transition for physicians, addressing ergonomics, and digitizing prior images;
  • “Establishing a new workflow” touches on new positions, choosing a PACS administrator, setting up an efficient workflow, downtime, and trouble-shooting; and
  • “Digital compliance” looks at MQSA regulations, digital inspection, printer problems, ACR guidelines, ensuring a solid medical audit, and transcription.

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Mastering the Revenue Cycle

By Kris Kyes

The revenue cycle is more than just billing and collections, according to Patricia Kroken, FACMPE, CRA, of Healthcare Resource Providers LLC, Albuquerque, NM. During her “Maximizing the Imaging Center Revenue Cycle” presentation at the 34th Annual Meeting of the American Healthcare Radiology Administrators in Las Vegas, held July 30–August 3, 2006, Kroken stressed that patient scheduling, patient registration, service provision, and reimbursement are also vital parts of the cycle.

Scheduling and Registration

The first step in controlling the revenue cycle is taken at the front desk, with standardization of all scheduling and registration practices, said Kroken, a former radiology practice manager. She warned that mistakes at this point can make denial of claims inevitable if information is missing or incorrect, adding that, too often, collecting insurance, co-payment, preauthorization, and patient data is cumbersome, and it is usually the responsibility of the practice’s lowest-paid staff.

Because these workers are the foundation of the imaging center’s reputation, as well as the source of complete information that leads to smooth reimbursement, they need ongoing training, Kroken said. She advised that staff be asked to think of themselves as ambassadors for the center, remembering to smile and make eye contact. At the front desk, no staff conversations or personal phone calls should be permitted, she said, adding that cross-training other staff to help when the front desk is overwhelmed can also decrease the frequency of mistakes.

Kroken recommended training the scheduling staff to help patients prepare for the study; otherwise, the procedure may have to be cancelled or at least delayed, decreasing both revenues and the center’s reputability. She said staff should advise patients: of any contraindications; to bring insurance cards and physician referrals/orders; how to reach the center and where to park; how long before the study to arrive; and whether any special oral-intake restrictions or clothing requirements apply.

Kroken also suggested making these instructions available on the center’s Web site and in the patient-preparation handouts that the center gives to referring physicians for distribution.

Service Provision

Maximizing revenues means improving throughput. Kroken said that all necessary information should be in the RIS or patient folder when the patient arrives—the technologist should be notified, the patient should be taken to the dressing area promptly, and the study room and equipment should be ready.

Radiologist-controlled protocols should be standardized, she added, so that staff can stop memorizing variations and so that consistent amounts of time can be scheduled for examinations. Otherwise, differences in study times will cause excess waiting times for patients and staff will stay late.

Kroken said that because radiologists and technologists are paid the most, they also must be the most efficient staff. Improve inefficient systems first; after that, a RIS can help make the most of staff time. Techs should be prevented from performing duties other than verifying contraindications and patient preparation, performing the study, and communicating with the patient and radiologist, she said. Less costly personnel can handle patient escort, room prep, paperwork processing, and RIS data-entry.

Billing and Reimbursement

In an ideal world, Kroken noted, payment for insurance claims submitted electronically would be received in 4 days. However, it is more common for denials, follow-ups, research, and resubmissions to make the payment lag last 60 to 90 days—or more. An electronic submission method can be helpful in shifting this process toward shorter delays (because even denials are received more quickly), she advised, but the obvious solution is to prevent denials at the start.

Kroken noted that this can be achieved through the acquisition of complete data, including insurer and guarantor contact information, patient ID and plan numbers, referrer ID and written orders, documentation of procedures, preauthorization, signed waivers for insurance billing, and the radiologist’s report. Problem claims should be investigated to find where any deficiencies are originating.

Because many patients are uninsured, Kroken recommended giving attention to self-pay procedures, including offering payment plans for large balances and accepting credit and debit cards (in person, by mail, and online). Cash payment in full saves staff time, so offer a discount to encourage it, she suggested.

Kroken stressed that the revenue cycle can be used to the center’s advantage if it concentrates on avoiding missed opportunities. For example, she advised that staff assign priority to the largest outstanding balances and contact patients to obtain any missing information for insurance claims. According to Kroken, adopting a philosophy that stresses helping each patient find a way to pay the imaging bill will help the center flourish.

Kris Kyes is technical editor of Axis Imaging News. Contact .