Ideas for Hospitals, Centers, and Practices

More Codes, Less Headaches

Billing can be the biggest bane of a radiologist?s practice. Missed dollars, billing denials, and slow reimbursement can make running a successful imaging facility difficult. Unfortunately, thanks to a recent move by the federal government to put the United States in line with the rest of the world, billing might be getting even more difficult.

When the US government adopted the International Statistical Classification of Diseases and Related Health Problems (ICD) 10 codes, it effectively increased the number of medical billing codes from about 17,000 to more than 160,000, meaning that everything from a standard x-ray to the most esoteric nuclear imaging test has been given a new set of codes?often multiple ones for each limb, organ, and procedure. The good news is that Zotec Partners offers a medical billing service that is up-to-date on the latest codes, and can lift the burden of billing completely from radiologists? shoulders.

Scott Law, president and CEO, Zotec Partners

The service that Zotec offers is a complete billing package, handled by its on-site staff of radiology billing experts. While the service will not necessarily increase revenue, it will reduce expenses associated with billing, find dollars that have been missed, and make physician and staff management more efficient.

The company can work with any type of practice?from general radiology to subspecialty to interventional radiologist groups?in any environment (hospitals, imaging centers, or outside facilities). The service is specialized for each practice, reflecting the specific contracts that have been negotiated with insurers and other payors. And, to make the process even easier for busy radiology practices, Zotec?s experts handle the appeals on rejected payments and keep the pressure on payors to capture imaging dollars in a timely manner.

This will become particularly crucial as the ICD 10 codes become common throughout the insurance industry. Zotec has radiology-specific coding expertise, including a team dedicated to interventional radiology. And expertise is a key part of the equation, according to the company; because of the ICD 10 codes, it is estimated that an additional 10% of claims will be returned because of erroneous billing codes.

One of the company?s latest innovations is an automated coding assisted technology that?s integrated with its billing software, which should increase accuracy and optimum payments in the new ICD 10 coding environment.

According to Kim Snyder, the company?s corporate director of coding, the automated system is able to minimize denials before a bill is even sent. ?With our system, which is the most sophisticated on the market, when a coder enters a code, they can [run it] through the edit function to see if it will pass,? she said. This makes billing efficient, with a 45- to 60-day window being the norm.

This capacity to test a code’s ability to pass an insurer’s scrutiny has become particularly demanding with the new ICD 10 codes, which offer a greater level of specificity that is often lacking with radiology reports. “With radiology, you often don’t get a lot of detailed information in the reports, and a lot of radiologists are struggling,” said Mark Isenberg, Zotec Partners’ vice president for business development.

Among the additional services Zotec offers is ongoing education in dictation, an important part of producing detailed reports that helps optimize reimbursement.

There are several other layers to the problems ICD 10 could cause in the short term, said Isenberg. First, it is unclear when and if it needs to be adopted. He cited workers’ compensation insurance-which appears to be exempt from the ICD 10 requirements-as a particularly problematic situation. In addition, because of the sheer number of new codes, there are now more digits, potentially setting up a parallel to the Y2K fiasco with older systems, limited to five-digit codes unable to be adapted to the new code set.

Even with these short-term problems, Isenberg says, “There are legitimate purposes for moving forward [with the ICD 10 codes], especially in the move to high-quality medicine.”

While the most common way that Zotec offers its services is through its paperless process, with billing performed by its staff, a licensed version of its software is also available for those practices that want to keep billing in house.

—C.A. Wolski

Look What the Wind Blew In!

A new MRI just landed right where it?s needed. The Phoebe Sumter Medical Center in Americus, Ga, has served its community for nearly a century. On the evening of March 1, 2007, a devastating tornado with winds reaching up to 165 miles an hour completely destroyed the hospital. Luckily, rescue workers and hospital staff were able to evacuate all 70 patients in the hospital that night before it was destroyed. Now, more than 3 years later, the Phoebe Sumter Medical Center is housed in an interim facility that includes a donated new MAGNETOM? ESSENZA MRI system, compliments of Siemens Healthcare.

Siemens donated a MAGNETOM ESSENZA to the Phoebe Sumter Medical Center.

In January 2008, Siemens Healthcare announced that it would donate a MAGNETOM ESSENZA, worth approximately $800,000, to the hospital once the facility was rebuilt and could support the new system. The story of the medical center?s destruction captured the attention of Siemens Healthcare during its ?Win an MRI? contest in the fall of 2007. The Phoebe Sumter Medical Center, along with other rural and community hospitals without an MRI system, submitted a video pleading their case for why they should be the winning recipients of a new 1.5T MAGNETOM ESSENZA MR system. While Sumter Medical was not the primary winner, the disastrous impact of the tornado on this rural facility and the resulting profound effect on the community that relies on it for both urgent and routine health care struck a chord with the folks at Siemens.

In a generous gesture, the manufacturer decided to double its original donation. Siemens decided Sumter Medical deserved an MRI, too.

Now, a year and a half later, with an interim facility equipped to house the new MR, the Phoebe Sumter Medical Center has taken possession of the donated system. This is a huge step for the hospital and its ability to service the medical imaging requirements of its community. ?Siemens stands in solidarity with Sumter and hopes that the donation of the MAGNETOM ESSENZA will play an important role in helping the facility start anew and offer the best care possible,? stated Jeffrey Bundy, vice president, Magnetic Resonance, Siemens Medical Solutions USA Inc, in an earlier press release.

The MAGNETOM ESSENZA by Siemens Healthcare, which was introduced to the market in October 2007, was developed with the small hospital market specifically in mind. It was designed to be an affordable option and reliable system that can support a hospital’s clinical and financial success. This ultra-short, lightweight 1.5T system delivers the flexibility, accuracy, and speed of Tim? (Total imaging matrix) and a powerful new innovation, the IsoCenter Matrix coil.

The Phoebe Sumter Medical Center plans to open the doors of its new hospital building in late 2011 or early 2012.

—Carol Dawson