Advancing the Business of Radiology
The leading professional organization for radiology business management professionals in any radiology setting.
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Welcome, Leaders!

As a practice leader, you have come to the right place for radiology business professionals who are dedicated to supporting and enhancing their vocation, investing in their career and pursuing higher goals. You have the respect of your physicians to help guide, develop and maintain a practice/department and you strive to advance the profession and improve the business of healthcare.

RBMA is the place to turn for inspiration, resources and practical tools you can’t find anywhere else.

Leaders
“The RBMA provides critical information through expertise and dedication to the field of radiology business. Being a member of RBMA as an administrator has provided me with the most up to date information and networking opportunities to assist me in performing at the highest level.”

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Welcome, Radiology Business Managers!

As a manager you have come to the right place for information and resources that will assist you in coding properly and obtaining the best possible reimbursement for your practice.

RBMA connects radiology business managers with resources and practical tools to help you succeed.

Manager
“I have been in the radiology business for 34 years and have seen many changes. One of the best changes is how the RBMA has grown and provides us with the necessary tools that we need in order to help us continue on this rocky road.”

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Enroll in RBMA U’s Radiology Business 101 – an overview program covering the basics of radiology business as defined under the RBMA Common Body of Knowledge.

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RBMA’s innovative new practice analytic solution that takes benchmarking to new levels through the combination of your practice’s information and state-of-the art technology and data query protocols.

 

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Welcome, Coders!

As a coder, you have come to the right place for for information and resources that will assist you in coding properly and obtaining the best possible reimbursement for your practice.

RBMA connects coders with resources and practical tools to help you succeed.

“RBMA membership offerings, either the list serve or conference attendance, has provided up to date trends in coding, payor policy and practice management issues. The topics discussed through the list serve either coding or practice management has helped my practice be proactive.”

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Resources For Coders

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Prepare for tomorrow. Order your ICD-10-CM Toolkit today.
The IDC-10-CM Toolkit designed by Coding Strategies (CSI) and Radiology Business Management Association (RBMA) gives the busy radiology administrator all of the tools needed to prepare the practice for the implementation of ICD-10.

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Welcome, Marketers!

As a marketer, you have come to the right place for information on the state of imaging today and how to effectively market your radiology practice by incorporating tools and strategies including social media and today’s technological innovations.

RBMA is the place to turn for inspiration, resources and practical tools you can’t find anywhere else.

“The RBMA Marketing Conference is a great way to network with colleagues from around the country to gain different ideas and perspectives without the threat of direct competition.”

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A toolkit designed specifically for radiology marketing, includes samples forms and ideas.

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Resources For Marketers

5 Steps to Effective Social Media Measurement
If you’re going to invest time in social media, you need to measure performance, but it can be difficult to identify relevant metrics.

How to Generate Compelling Content Ideas for Your Online Customer or Member Community [Infographic]
Are you looking for content to fulfill your new content marketing strategy, but don’t know where to start? Try these 10 great content ideas – plus a bonus idea – to jump start or breathe new life into your efforts.

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Welcome, Vendors!

As a vendor offering radiology products and services you have come to the right place to find your target audience. RBMA attracts decision-makers with buying power.

RBMA members rely on vendors to keep them informed of new technologies, developments, and products for their practices.

“RBMA provides the foundation for connecting with the right people. We appreciate the opportunity to visit with our existing clients as well as meet new prospective clients.”

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Resources For Vendors

Start planning your 2014 marketing program with RBMA today! Consider a Global Level Sponsorship. Contact daphne.gawronhski@rbma.org for details.

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Today_Coders_Must_Also_Be_Communicators

(Coding) Permanent link

Bundling of payments for services transfers much of the financial risk of providing services from payors to providers and incentivizes hospitals and radiology groups to provide services efficiently. Coders and billers definitely play a role in helping a practice manage this risk and keep its own house in order, explains Kathy Pride, RHIT, CPC, CCS-P, CPMA, senior vice president of Coding and Documentation Services for Panacea Healthcare Solutions.

In her presentation “Radiology Practices Work Smarter, Not Harder” at the 2016 RBMA Radiology Summit, Pride explained that although bundled codes have been around for quite some time now, many practice administrators, hospital administrators and finance departments still tend to look only at charges going out the door and not at what is actually submitted and paid.

“Years ago, what you had to tell the doctors was just do your work, we will bill it out and you will get paid,” she said. “That is not the case anymore.”

Supplies is a classic example. With Ambulatory Payment Codes (APCs), the incentive to use more expensive supplies without medical need was eliminated. Yet, Price said she still regularly runs into administrators, managers or doctors who have met with a vendor and gotten the impression that a supply that costs three times as much is fine to use because one can charge three times as much.

“I have to make them understand that yes, you get to charge three times as much, but in actuality, you are not making a dollar,” she said. “You are just spending more money.”

Other places practices lose money when there is not communication and education going back and forth between clinicians, administrators and coders include procedures and services that are either written off or down coded because of lack of medical necessity documentation. Charges that get stuck in a billing que until they become so old they can no longer be billed are also an issue.  

“I talked to one radiology group and they said they had not seen or talked to a coder in three years,” Price said. “I thought, either you are an amazing documentation guy or they are just not telling you what is going on.”

While administrators, practice managers, radiologist and finance staff need not be coders, they should all have a handle on where their money is and coders can help with this. Price recommends that coders keep the lines of communication open and help in the following ways:

  • Provide regular reports not just on what charges are going out but what charges are getting paid.
  • Look at how much money is being held in ques. Understaffing, lack of training or too many edits stopping charges for review can create backlogs. “If you go over the time limit to submit a charge, you just did that study for free,” she said.
  • Get reports on what is written off for lack of medical necessity and track them back to see where there may be opportunities to reduce that number. It is not uncommon to find that a particular protocol is at the root of the issue and by simply making a change to the protocol, the practice or hospital can save a lot of money in reduced write offs.

 


Know and Understand the Good You Do

(Vendor) Permanent link

In fee-for-service payment systems, the measure of the “good” you do is how much you do. More and faster is better. However, developing a more nuanced understanding of value in medical imaging is being encouraged by new payment approaches being adopted by government and private payers. 

Alternate payment methodologies (APMs) are a euphemism for risk assumption by providers and the winners in these methodologies will be the practices that have the data to know and understand the “good” they do for patients and the populations those practices serve. Being able to track the data to extract the information needed when it comes to understanding risk or exposure in a particular realm is paramount to success in a value-based future. If a practice enters into value-based contracts, risk will be assigned to the group in some manner, and if practices do not know the risk they are accepting, they could suffer large and even debilitating financial losses.

Let’s say your hospital offers the practice the ability to participate in a bundled payment scenario for hip replacement. The hospital offers to pay the practice $50 for their role in the patient care continuum for each hip-replacement patient. If the group does not understand the total continuum of care they are being asked to cover, how does the group determine if the offer of $50 is or is not reasonable? Does this episode of care cover 30 days or 90 days? How many medical imaging encounters are included in this episode of care? Also of concern would be how physicians in the market area treat patients within this episode of care. What would happen if the group assumed plain X-rays were the diagnostic utilized for this bundled payment approach, yet all of the orthopedists in the area ordered CTs or MRs for participating hip-replacement patients? Having the data from which to extract the information necessary to evaluate this offer is truly pivotal in the decision process.

Most small practices and even many larger practices contract with external vendors to affordably obtain the analytics necessary to understand their market and the practice patterns of the referring physicians in that market. Nationally available software options come in various levels, from the very basic to expertly advanced that can provide the necessary breadth of information from the data a practice is capable of entering. Determining the spend necessary to attain the information required from the appropriate level of data analytics to assess the risk being assumed is extremely important.

At IMP, our answer to the question of affordably understanding risk in alternative payment methodologies involves the application of economies of scale. Our analytics platform allows a practice to migrate from analytics of codified and volumetric data (the data which can be assigned numbers such as CPT or ICD10 codes) into the realm of non-codified data (the data contained within the dictated imaging reports, EMR notes, etc.) at a price point below market rates because IMP can bundle the purchasing power of multiple practice collaborations and groups across the country.

Another advantage is that analytics accessed through a collaboration between multiple practices allows those practices to learn from the others in the collaboration in two very important ways. First, the ability to compare data across providers within the collaboration whether that collaboration is regional or national in nature. This allows for development of an understanding of the local or national market and possible identification of best practices. The second is the ability to learn through direct interaction with other collaboration partners and discovering how they are able to draw information from the data available. In the IMP solution, both the software and the company are available to assist with the process of data collection and information extraction. This is in addition to the ability to collaborate with peers viewing the same data with and from a different perspective, allowing for the realization that the implications originally seen from one perspective may not have been all encompassing or as thorough as once believed.

As alternative payment methodologies grow in popularity and more income is at risk, having the data and the understanding of the value contributed by the practice in any payment model will be essential.

Keith Chew, MHA, CMPE, FRBMA, senior vice president of Strategic Positioning & Consulting Services for Integrated Medical Partners (IMP), an RBMA Thought Leader partner, contributed this guest post to the RBMA Let’s Talk blog. Learn more about IMP at http://integratedmp.com. 

  

Seven Tips for Marketing Interventional Radiology

(Marketing) Permanent link

When practices seek to expand their interventional radiology volumes, it is important to appreciate the differences between traditional radiology marketing focused on diagnostics and interventional radiology which is more treatment oriented. Dianne Keen, Director of Business Development & Marketing for Northside Radiology Associates in the Atlanta area, has 15 years of experience marketing radiology services and procedures and says there are some key differences in marketing interventional radiology that one should keep in mind. Here are her tips.

  1. Understand the procedures you are marketing extremely well. “You don’t have to be clinically trained to market interventional procedures, but you absolutely have to have a clear understanding of the clinical components of IR.,” she says. “If you don’t understand what you are marketing, your value as an integral part of the IR team will be very limited and you could compromise the relationship with the referring physician.  Ultimately, the patient care process will suffer.”
  2. Have a physician champion. “Because collaboration is so important, I don’t think you can successfully market interventional services if you don’t have an interventional radiologist who is willing to be a champion and go out and meet with referring physicians for peer-to-peer conversations,” Keen says.
  3. Focus your campaign around education. “There is such a huge need for educating both the referring physicians and the public about interventional procedures, particularly the many new ones or the ones that have evolved,” she says. “The person in charge of marketing interventional radiology is really an educator.”
  4. Be very detail-oriented in planning events like educational dinners or lectures. Check to see if there are other events going on at the same time that might pose a conflict. For example, in Georgia, bible study on Wednesday night is common so Keen avoids scheduling patient education events on Wednesday nights. Also be very careful about choosing your venue. For physician educational dinners, choose a place that physicians will want to visit. Make sure there a private room with audio-visual technology. “Don’t just take the venue’s word that you will have a private room with a door,” Keen cautions. “Go out and actually look at the facility before you book it. Pay attention to the AV set up.”
  5. Offer appropriate enticements like CME. “Referring physicians have many demands on their time,” Keen says. “They really appreciate it if you can arrange CME credit for attending your educational event. It definitely increases attendance.”
  6. Know your audience. “When going into a referring physician’s office, bring news and information that is of value,” she says. “What will help the office with the referral process? What information can you provide that will help them identify the appropriate patients for a particular IR treatment? Are there questions that their patients ask that they may need help answering? We recently provided education on port placement and care for an oncology practice and they loved it. Although they used ports all the time for their chemotherapy patients, the staff actually knew very little about how the ports were placed and sometimes had trouble answering questions about port care.”
  7. When planning direct-to-consumer campaigns, be cautious about outsourcing all of your media buying. Because interventional procedures are so clinical and so specific, even a very good media buyer may be out of their depth when it comes to interventional radiology. “In the Atlanta area, radio is typically a good media option because we spend so much time sitting in traffic,” Keen says. “However, to be effective, my radio ad needs to be on the right station. If I’m trying to educate patients about uterine fibroid embolization, I need to reach people likely to have fibroids--women between the ages of 30 to 50. If my brilliant UFE ad runs on a hard rock station that draws a primarily male audience, I have wasted my ad dollars and wasted an opportunity to reach the appropriate potential patient.”

For a good example of education-focused patient-facing interventional radiology marketing, see Northside Radiology’s UFE website at www.northsideradiology.com/uterine-fibroid-embolization-ufe.php. 

Free-standing Radiology Has Price Transparency Edge

(Management) Permanent link

Imaging patients increasingly demand to know the cost of procedures up front. After all, with both high co-pay and high deductible health plans, they are on increasingly responsible for a larger share of their imaging costs. Satisfying this demand is not so easy, however.

At the ACR’s Crossroads of Radiology meeting last month, University of Pennsylvania radiologists Mindy Yang Licurse, M.D., and William Boonn, M.D., presented a poster on their experience calling six local hospital radiology departments and five stand-alone imaging centers to ask how much three different procedures would be — a two-view chest x-ray, a CT of the abdomen/pelvis with contrast and a pelvic ultrasound.

As will not surprise most RBMA members, Drs. Licurse and Boonn found that getting a price estimate took longer and required more phone transfers when the practice was hospital-based. For the stand-alone imaging centers, only one of the five took longer than five minutes to get a price quote and none required the call to be transferred to answer the question.

Price transparency has been touted as a way to reduce the variability in health care costs, and indeed, the researchers found that there was greater variability in the costs for the procedures at hospitals than at the stand-alone imaging centers. 

For practice managers at both hospital-based practices and stand-alone imaging centers, the findings have some interesting implications. If surveys done on patients are correct and they do indeed value price transparency and low predictable costs, will it lead to more and more patients opting to go to stand-alone imaging centers? Do hospital-based practices need to do more to make their procedure prices easy to find? Perhaps most importantly, what really counts as price transparency? Hospitals and health systems have generally responded to laws requiring the publishing of prices with posting their charge masters online. However, few patients pay the charge master rate and many imaging centers have started using vendor services that calculate individual cost estimates based on the patient’s insurance. Knowing the estimated patient portion of the bill allows imaging centers to among other things collect the patient portion of payment due up front and also show patients how they may save money by taking advantage of a steeply discounted cash-pay rate.

For those interested in learning more about serving patients who are increasingly cost conscious, Greg Thomson, CPA, vice president of practice management for Zotec Partners, will be speaking about reimbursement strategies for high deductible health plans and greater cost sharing with patients on Monday, Sept. 26, in New Orleans at the RBMA Fall Educational Conference. To review the other conference presentation options, go to rbma.org/FEC_Schedule.

What to Know About the MACRA Comment Period Closing this Month

(Leadership) Permanent link

In late April, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for how it will implement the provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law last year. MACRA will have a tremendous impact on everyone in health care as it aims to curb the growth in health care spending by incentivizing value in health care services and rewarding providers who are able to reduce the total cost of care.

All proposed rules have a comment period to allow stakeholders to flag areas of possible concern and ask for modifications to the final rule to avoid unintended negative consequences of the rule. The MACRA rule’s 60-day comment period will end July 27, which means all medical organizations are currently working feverishly to finish and submit their comments. Radiology practice leaders should be aware of some of the things to watch for in radiology. Here are three big things to keep an eye on:  

  1. What protections will the American College of Radiology and other stakeholders ask for on behalf of smaller practices? MACRA creates two new payment system -- the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). MIPS essentially pits practices against each other in a competition over who can do the best across four categories of performance measures. The measures are: quality measures, advancing care information, clinical practice improvement activities and cost/resource use. Because MIPS is budget neutral, the extra money that goes to the highest scoring practices comes at the expense of the lowest scoring practices.

    To get out of participating in MIPS without a steep penalty, a practice can opt to instead participate in an APM. These are models with shared risk like a Medicare Shared Savings Program or a Next Generation Accountable Care Organization Model. However, smaller and rural practices may not be able to participate in an APM and they may be starting at a disadvantage in competing with larger and more resource-risk practices in MIPS. That makes the question of how will the rule will ensure a level playing field for this practices very important. The ACR has stated that it will “comment extensively on the MACRA proposed rule and its effect on small and rural practices.”
     
  2. How CMS could address problems with the advancing care information measures that are meant to encourage interoperability in electronic medical records. On June 3, the American Medical Association and 30 other specialty organizations, including the ACR, sent a letter to CMS and the Health and Human Services Office of the National Coordinator for Health Information Technology asking them to fix problems with the Meaningful Use measures for data exchange before these measures are simply rolled over into the new advancing care information category of performance measures in MIPS. Organizations may bring up these concerns in their MIPS comments as well.
     
  3. What should happen when there are not enough measures in a category in MIPS that are suitable for a specialty like radiology. The quality measures in the MIPS proposed rule replace the Physician Quality Reporting System (PQRS) program and many radiology practices are currently facing reimbursement cuts because of problems reporting under PQRS. 

What to Know About the New Overtime Rules

(Management) Permanent link
The final rule covering new overtime protections for employees is now published in the Federal Register. The rule will go into effect on December 1 of this year, which gives practice managers some time to assess to which employees the new rules may apply and estimate the budgetary impact of the new rules.

Traditionally, radiology practice clinical staff have been hourly employees with overtime protections. In addition, radiologists, whether shareholders or employees, generally earn above even the new cap of a salary of $913 per week ($47,476 annually) for full-time work to qualify for overtime protection. However, salaried administrative, billing and customer service professionals in a practice may very well fall under the new rule depending on how much they currently earn.

A good first step is to get a handle on exactly how many hours these employees currently work. Flexible policies that allow employees to work from home or remotely can complicate measuring. Employees often appreciate the ability to catch up on answering emails after hours or finish a big project from home. However, this means that they may be working more hours than you may realize.

Ensure you and your affected executive, administrative or professional employees understand the full requirements of the new rule and work together to address how you will measure hours worked fairly and accurately.
The key provisions of the new rule are:
  • White collar workers who earn $913 per week or less for full time work are no longer exempt salaried employees and must be paid overtime if they work more than 40 hours in a week. (The previous cap was $455 per week.)
  • Salaried employees who do not meet the legal criteria for an executive, administrative or professional employee (i.e., they are not a white collar worker) must be paid overtime if unless their salary is the annual equivalent of the 90th percentile of full-time salaried workers nationally ($134,004). Only these “highly-compensated” workers remain exempt.
  • You can use nondiscretionary bonuses and incentive payments (including commissions) to satisfy the new salary level if an employee earns just under $913 per week. However, this cannot be more than 10 percent of the new standard salary level.
  • Going forward, the salary threshold levels for an overtime exemption will be updated every three years starting in 2020.

If you have an employee that regularly works more than 40 hours per week, you have a few options.

  • pay the overtime
  • spread the work to other employees
  • hire part-time help as needed
  • raise the employee’s salary to make him or her exempt from overtime
  • lower the base salary of the employee to take anticipated overtime into account
The last option, while not in the spirit of the law, is not illegal. However, lowering base salary is rarely a practical option for an employer.

The U.S. Department of Labor has published a comprehensive guide (PDF file) to the overtime final rule for private employers. Read it here.

ICD-10 Coding Fix for Cancer Screening of Current Smokers Effective July 5

(Coding) Permanent link
New coverage decisions certainly come with some growing pains. The addition of Medicare coverage for low-dose CT lung cancer screening is a perfect example. Torn between the conflicting desires to both expand access to the only test recommended for detecting lung cancer early in current and former heavy smokers and ensure only reputable high-quality providers offer the test, the Centers for Medicare and Medicaid Services created policies and instructions that were at times confusing.

One area of confusion should be cleared up on July 5, however. That is the implementation date of five International Classification of Diseases Tenth Edition (ICD-10) diagnosis codes for LDCT lung cancer screening in current smokers. Previously, CMS had instructed providers to just use the ICD-10 personal history code ICD-10 Z87.891 (personal history of nicotine dependence). However, personal history codes are not meant to represent a current state and that created a problem for getting some scans of current smokers paid.

Starting with procedures with dates of service of July 1 or later, the Medicare administrative contracts (MACs) should add these five ICD-10 diagnostic codes for current smoker who had a Medicare-covered LDCT lung cancer screening test.
  • F17.210 Nicotine dependence, cigarettes, uncomplicated 
  • F17.211 Nicotine dependence, cigarettes, in remission 
  • F17.213 Nicotine dependence, cigarettes, with withdrawal 
  • F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders 
  • F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders
According to the ACR, it has received assurance that providers whose claims were held up by this issue for so long that the claim is now past filing deadlines, can still file the claim and be paid for it. They should not need to write it off because this was CMS’s oversight.

In addition, the ACR recently set up an email specifically for lung cancer screening coverage and payment issues. It is LCScoverage@acr.org. Its Lung Cancer Screening Resources page is at: http://www.acr.org/Quality-Safety/Resources/Lung-Imaging-Resources

What issues have you encountered with getting claims for LDCT lung cancer screening tests paid? Please comment below.

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