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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Resources For Leaders

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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

Ladies

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.

Libman Education
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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.”

More Resources For Practice Marketers:

Order your Marketing Toolkit today.

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

Click here to preview Table of Contents.

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

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How Marketing Can Get a Seat in the Boardroom

(Marketing) Permanent link

Ironically, marketing in health care has a bit of an image problem. In the age of Amazon and high customer service expectations, marketing has become critical to an organization’s success. However, health care leaders often view marketing as an extra that helps keep patients and referral sources happy but doesn’t substantially contribute to the core mission of the organization. 

At the PaRADigm conference in April, Janine Walker, business development and marketing director for Radia Inc., shared how she made her department a recognized asset within the 163-radiologist Seattle-area practice, while at the same time earning a spot in board meetings.

“I’m lucky because our organization recognizes the value of marketing, but it didn’t always,” she said. “When I first came on board, I was just the marketing girl they had hired to make people happy and our president would literally pat me on the head.”

Changing this culture took time and a lot of relationship building, but it has led to the practice becoming stronger, Walker said. She advocated for other marketing departments to do the same as there are many good reasons marketing should be at board meetings and part of strategic decision making. One of the biggest reasons is that marketing brings in the voice of the customer. Boards tend to be focused on operations and metrics that reflect revenue, but there is a much broader world of information out there that marketing has access to. Without marketing being included, boards run the risk of becoming somewhat isolated in what Walker called “the board bubble.”

“My team is in the trenches talking to the referring doctors all the time and our board needs to know what people are saying about them, and they are not going to know unless people are telling them,” she said

The other reason board members should include marketing is that the marketing budget is the shareholder physicians’ money and they need to understand and help guide how that money is spent.

“Your marketing people should be the face of your organization and you want the face of your organization to know what is going on,” Walker said.

But respect is a two-way street. Marketers also have a responsibility to earn respect by proving the value they bring to the organization. Walker describes herself as an “over sharer” and emails the market data and reports her department generates to a broad range of practice and hospital leaders so that they have access to the same information as she does. In one example, she started bringing the website traffic data to her regular meetings with the CEO and president of the practice because she found the data exciting. Even though they at first said they didn’t want that data, soon they were interested in it too and came to understand why spending money on things like keyword marketing actually paid off.

“I never ever go to a board meeting with a problem without offering a solution, so if you are a marketing person who wants to be at the board meeting, don’t go in without a solution,” she said. “And if you are on the board, think about what marketers are saying because your marketing person should be thinking about the global picture and how are you going to solve that problem.”

Using Structured Reporting to Simplify MIPS

(Coding) Permanent link

The Physician Quality Reporting System is the basis for the Merit-based Incentive Payment System’s quality dimension, which counts for at least 60 percent of a practice’s total MIPS score for the 2017 measurement year. However, achieving 100 percent scores on PQRS requirements has proven challenging for many practices. One major issue is that it requires radiologists to improve their clinical documentation in such a way that coders can easily catch and report the correct quality measures every time.

Coastal Radiology Associates in eastern North Carolina achieved near 100 percent scores on PQRS and they did it with structured reporting, explained Catherine J. Everett, M.D., MBA, FACR, Coastal Radiology’s president and managing partner, in her talk at the PaRADigm conference. Considering the importance MIPS and Alternative Payment Models will play in the future of radiology reimbursement, now may be the time to take a serious run at convincing your practice’s radiologists of the benefits of structured reporting.

According to Dr. Everett, structured reporting not only creates a more professional and easier to read report for referring physicians, but it also helps ensure the clinical documentation supports compliance with quality measures and prevents the need to downcode some claims because the documentation to support the actual amount of work done is simply not there.

She gave several examples in her talk about how Coastal Radiology Associates uses templates pre-populated with options, checklists and other structured reporting tools to improve documentation of PQRS measures. One such example is documenting radiation exposure time and number of images in final reports for procedures using fluoroscopy (Quality ID #145). At Coastal Radiology, the radiologists cannot continue filling out the report without entering data in the fields for radiation exposure time and number of images. Then, at the bottom of the report in a special comments field, the quality ID number is automatically added. Previously, the coders had to manually add this increasing the odds that it might be missed.

Another example is including radiologist documentation of correlation with existing relevant imaging studies for patients undergoing bone scintigraphy (Quality ID #147). Here the radiologists have the option of either saying they compared with previous studies or didn’t compare because there were no previous studies to examine. If there are previous studies and the radiologist doesn’t correlate with them, the radiologist also has the option of not saying anything at all in the report. However, now this silence is a deliberate action rather than something that is simply skipped among the many other things radiologists need document.

In addition, for CT guided biopsies, Coastal Radiology uses structured reporting to ensure documentation of face-to-face time with conscious sedation, Quality ID #145 for the fluoroscopy portion of the exam, and two additional quality measures:

  • Quality ID 130: Percentage of visits for which eligible professional attests to documenting a list of current medications.
  • Quality ID 436: Documentation of CT dose reduction techniques.

“Structured reporting is an efficient and effective workflow tool for radiology groups but the radiologists have to buy into the concept and the implementation,” Dr. Everett said.

Now that structured reporting will help with MIPS, radiologists may be more receptive to discussing this as an option to improve coding, billing and overall practice profitability.


RBMA Speaker Warned of WannaCry Vulnerability Weeks Before Attack

(Management) Permanent link

In May, the worldwide WannaCry ransomware attack hit more than 300,000 computers and other devices running Microsoft’s Windows operating systems in over 100 countries. The United Kingdom’s National Health Service was impacted especially hard – a reminder to many U.S. health care organizations about the need to take cybersecurity seriously.

Although the attack seemed to come out of nowhere, the vulnerability that the WannaCry ransomware exploited was something cybersecurity experts had been warning about for weeks. At the RBMA’s PaRADigm conference in April, David Anderson, an 8-year veteran of cybersecurity and self-described hacker, explained that a hacker group called The Shadow Brokers had released a series of tools believed to have been leaked or stolen from the U.S. National Security Agency. The NSA alerted Microsoft that the secret vulnerability in the Windows operating systems that the agency had been using was now out in the open, and Microsoft quickly issued a patch for both current and older versions of Windows. However, as is well known among cybersecurity experts, organizations rarely install patches as quickly as they should. It is a repetitive and somewhat tedious process that is easy to put off since most of the time nothing bad seems to happen, until of course it does.

“If you haven’t patched your systems for this monthly patch cycle, they are all vulnerable to really dangerous tools that have now been released to the wild and a bunch of people are looking at,” Anderson warned at PaRADigm, just three weeks before the WannaCry attack.

Patching is something that health care organizations’ IT departments need to have an established process for, he advised. Here are five of the tips he gave at the PaRADigm conference:

  • Use available software to audit your own systems and find where you are missing patches. Patch management solution examples include Nessus, Nexpose and OpenVAS.
  • Review your vendor contracts. Vendor products that connect with your system sometimes aren’t updated because the contract doesn’t spell out whose responsibility it is to keep the product updated and secure. Furthermore, sometimes organizations can’t update the vendor product themselves without voiding their product warranty. “An attacker doesn’t care who owns it,” Anderson said. “If it is vulnerable, they are going to go after it.
  • Check for old legacy systems that are kept around as backups and decommission them if you can. These are especially likely to have unpatched vulnerabilities.
  • If there is a patch that you are not going to implement, have a system for managing those exceptions.
  • Most important of all, give your employees training on how hackers attack through phone and email phishing schemes. Not all phishing schemes involve clicking on a link and hackers have become very good at making emails and calls look like they are coming from someone inside the organization that an employee would trust. “Employees are your first line of defense,” Anderson said. “Attackers have figured out that the easiest way into an organization is not breaking through the technology. It is convincing an employee to open the door for them.”

Fortunately, the WannaCry ransomware attack did not hit the United States as hard as Europe because of the time zone difference and a lucky break in finding a kill switch for the virus fairly quickly. However, hackers are always out there working on the next attack. It is wise to be well prepared. 


Interventional Radiologist and RBMA Speaker Runs for Congress

(Leadership) Permanent link

On May 15, Stephen Ferrara, M.D., FSIR, announced that he would run for Congress in Arizona’s 9th District against current representative Kyrsten Sinema (D-Ariz.). If he wins, he would become the first radiologist to hold a seat in Congress.

Improving quality and value in health care through policy is one of Dr. Ferrara’s passions, and he spoke at length about this issue at the RBMA’s PaRADigm Conference in April. We asked Dr. Ferrara a few follow-up questions about why he is running and what comes next.

Why did you decide to seek election to Congress?  

I began my life in public service in 1991 when I joined the Navy at the outset of the first Gulf War. I never expected to stay for 25 years, but I found the opportunity to serve both my country and my patients to be incredibly rewarding. In the Navy, I had the chance to delve into many different policy areas such as combat medicine, medical diplomacy and population health. This showed me firsthand the role that not just the military, but also the United States plays on the world stage. Prior to being appointed as the Navy’s Chief Medical Officer, I was able to serve as a Congressional Fellow on the Energy and Commerce Committee where I worked intimately on the bipartisan legislation that became the Medicare Access and CHIP Reauthorization Act (MACRA). This experience cinched the deal for me that Congress is still the place where we can make great things happen for America.

How do you think your experience as a radiologist may help you in Congress? 

Health care is quite possibly our single biggest domestic issue. It consumes nearly a fifth of our economy and affects each American in a very personal and economic way. Having health care professionals in Congress to inform and direct these policies is important, but having the right kind of health care leader is even more important. Radiologists are unique in our perspective on the health care system as a whole. We interface with every other specialty and every care environment. This gives us singular experience when formulating and recommending policies to the other members of Congress who are looking for guidance.

Are there legislative issues pertaining to radiology that you hope to influence positively if you are elected? 

Definitely. Now that we’re into the value-based paradigm in health care, radiology has a great story to tell. I’m eager to tell my fellow legislators and policymakers how imaging and image-guided interventions get patients diagnosed and treated more accurately and efficiently, saving billions of dollars in health care costs while improving lives. I’ll ensure they understand that diagnostic screening exams save thousands of lives and billions of dollars, and that these services need to be protected in law and in reimbursement regulation. From my year on the Energy & Commerce Committee, I know what a difference it makes to have Congress understand what radiology does and what an important impact we have on patients each day.

What is your view of the Affordable Care Act? 

My home state of Arizona had the first county in America to have no insurers on its exchange. That’s not fair to patients. Families today are bearing all of the costs for none of the care. So the best thing about the current health care debate is that we’re talking so much about health care. Spending $3 trillion per year and leaving millions uninsured and/or bankrupt is unacceptable. We can, and must, do better. Our children can’t afford the bill we’re handing them or the dysfunctional system that they’re inheriting. The costs are already crowding out education, infrastructure and defense. The Affordable Care Act is a product of what happens when even well-intentioned people who don’t understand health care try to fix it. More of the same is in the works. We need people who understand the subject to redraw the blueprints for change. We also need to work together. Health care is too complex of an issue to go it alone. It requires bipartisan cooperation on the front end, but more importantly, both sides need to own it and support it going forward throughout implementation.


5 Tips for Improving A/R Management

(Vendor) Permanent link

The problem of a growing percentage of revenue being tied up in A/R is common to many practices says Carrie Moneymaker, operations manager for Zotec Partners, a leading revenue cycle management company. 

“Practices love to look at their payor mix and say ‘I have 25 percent Blue Cross/Blue Shield, 20 percent Medicare and my commercial is this or that — I’m so healthy.’ Then you look at the A/R and they have 35 percent of their A/R as aged patient responsibility,” she says. 

The reality is that patients are now the number one payors, and this has a big impact on A/R management. Based on recent Kaiser Family Foundation research, average deductibles for covered workers have risen 12 percent, to $1,478 since last year. This means that practices need to put more effort into managing their A/R to ensure a healthy cash flow. 

So what can be done? Moneymaker has three tips: 

  1. Actively engage the patient in the payment process early on and make paying the patient portion as easy as possible. “It is a little bit taboo to go out there and ask patients for this money, but you have to collect it as soon as you can in the revenue cycle,” Moneymaker says. She adds that practices should ideally have a consumer-driven workflow focused on obtaining payment from the patient that recognizes that different patients have different payment behaviors. Zotec uses data on patient payment behavior over time to help front desk staff know which patients promptly pay bills sent to them after service and which ones should be asked for their portion of the payment at the time of service.
  2. Make sure claims going out are as clean as possible. Zotec works directly with almost all the carriers in the claims submission process which allows it to have a very robust front end rules engine to ensure all needed information is there before the claim goes out. “That mitigates the possibility that claim is going to come back denied and because we are going direct to the carrier, we have a cleaner handshake with them,” Moneymaker says.
  3. Have established timelines for follow up. Zotec has eliminated paper follow up for most claims and automated claims tracking so that if a claim to a carrier that normally pays within a certain time period doesn’t come through when expected, Zotec can follow up right away to make sure the claim was received and there isn’t a problem. “We are not waiting 20, 30, 45 or more days to ask ‘Where the heck is that Blue Cross adjudication or message back on that claim?’ We are reaching out to them very quickly to say ‘Hey, where is the feedback on that claim?’” Moneymaker says.
  4. Avoid rework. When claims go out clean and organized, there is less work when they come back. “The cleaner the claims go out, the cleaner they come back and that means that there is less work for your team to figure out what is going on when the claim comes back,” Moneymaker says.
  5. Employ a data-driven hold on claims where the patient portion needs to be collected first before the rest of the claim can be submitted to the carrier. Zotec uses an advanced tool called ZITCH, which stands for Zotec Intelligently-Timed Claim Holds, to identify the individual medical encounter and hold claims long enough for patient deductibles to be paid and processed. “Practices sometimes will hold claims for a period of time during January or February because of high deductibles, but with the deductible taking the patient the entire year to pay, now you cannot just say the first months of the year are the months for high deductibles. It can last through the entire year,” Moneymaker says.

Zotec is an RBMA Thought Leader sponsor. More tips and information about Zotec’s radiology revenue cycle management tools is available at https://www.zotecpartners.com/radiology/revenue-cycle-management 

 

 

Paradigm Day 4: What Comes Next for the RBMA

(PaRADigm) Permanent link

The final day of the RBMA’s first Paradigm conference in Chicago began like all the others, with sun glinting on the Chicago river outside and warm temperatures in the forecast. RBMA members who had partied the night before with live music from the RAD Keys and Concert T were still up bright and early for the education. Their dedication was rewarded with an introduction to all the newly elected RBMA Board of Directors officers and members by 2017-2018 RBMA president Tom Dickerson, Ed.D. Dr. Dickerson also helped introduce an information-packed presentation from Ingrid Lund, Ph.D., from The Advisory Board Company. 

While previous general sessions held Sunday through Tuesday had set the stage for leadership in times of disruptive change and new technology, like artificial intelligence, on Wednesday Dr. Lund dove into how these trends are connecting up with health policy and regulatory efforts. There are seven main trends that The Advisory Board Company is watching, she said.

  1. Medicare will remain committed to shifting away from fee-for-service payment toward more risk-based payment methodologies as a way to try to bend the cost curve.
  2. MACRA (the Medicare Access and CHIP Reauthorization Act) is not going anywhere even as Congress and the Trump Administration attempt to repeal and replace the Affordable Care Act. Population health initiatives will only grow in importance, Dr. Lund predicted.
  3. The private payor market is also moving toward more risk-based payment models, albeit somewhat more slowly.
  4. Consumer-driven health care will continue to increase with consumers getting more access to both cost and quality information.
  5. There is a potential for a rise in the number of uninsured as portions of the ACA are changed.
  6. The issues of new competition, rising practice costs and increasing merger and acquisition pressure will continue.
  7. The risk of physician burnout from all these changes is at an all time high.

How individual radiology groups Dr. Lund works with are addressing these trends and challenges differs somewhat by location. She showed a slide of patient priorities and emphasized that patients in different markets want different things. On top of that, state legislative activity will become more important, she predicted, as health care change runs into challenges at the Federal level. This means that practices in different states may face different reimbursement challenges. 

“We are all being forced to be a little more creative and innovative,” she noted.

 Luckily the other morning sessions offered expert insights on many of these topics. For example, Pradeep Albert, M.D., a radiologist, spoke about how imaging centers can manage the shift from being paid on volume to being paid on value.  Samir Shah, M.D., medical director at vRad, and and Raymond Tu, M.D., chair of the American College of Radiology Medicaid Network, teamed up to speak about the quality component of value and how radiology needs to better understand and measure error rates. In addition, Ronald Bucci, Ph.D., radiology solutions architect for Philips Healthcare, spoke on population health and current issues in health care administration.

The synergy between all these sessions of Paradigm was not accidental. It was the work of the RBMA Programs Committee, under new president-elect Christie James, and the staff of the RBMA. “Paradigm would not have been possible without the RBMA staff,” said outgoing RBMA Board of Directors President Jim Hamilton. “I kept having these moments of nostalgia all week as I looked around and remembered the issues and decisions we faced creating Paradigm.”

Next year’s Paradigm conference will be held in San Diego and Jim Hamilton was quite ready to turn over leadership to Dr. Dickerson for this one. It had been an eventful year, but a rewarding one too. 

Paradigm Day 3: A New View of AI

(PaRADigm) Permanent link

Last year, at the Machine Learning  Conference in Toronto,  Geoff Hinton, Ph.D., one of world’s leading experts on artificial intelligence, remarked that “if you work as a radiologist, you are like the coyote who is already over the cliff but hasn’t yet looked down and so doesn’t realize that there is no ground underneath him. I think we should stop training radiologists now.”

The reason Dr. Hinton offered this gloomy prediction was that artificial intelligence has the potential to someday become even better than humans at reading medical images. When this day comes, it will create a sea change for radiologists and the business of radiology practice management.

On the third day of the RBMA’s Paradigm conference in Chicago, attendees turned their attention toward this issue with AI. They started the day with a presentation from Christopher Austin, M.D., Global Radiology Solutions Director at GE Healthcare, and ended it with a presentation by Keith Dreyer, D.O., Ph.D., FACR, FSIIM, one of the leading experts on computer applications to medical imaging and chair of the American College of Radiology’s IT and Informatics Committee.

Both Dr. Austin and Dr. Dreyer agreed that AI would require a major paradigm shift in how radiologists and radiology practices view their role in patient care.  But they disagreed with Dr. Hinton on the potential for AI to put radiologists and radiology practices out of business.

 Rather, AI would allow radiologists to focus their energies on the jobs AI cannot do as well, such as those that require human creativity. The image Dr. Dreyer evoked was of the centaur, the mythical creature that was half man and half animal. In the future, radiologists will be able blend their human evolutionary intelligence with artificial intelligence tools to create something greater than either type of intelligence can offer on its own.

 Furthermore, the RBMA and its members will need to be there to guide the implementation of AI and work out all those pesky business details the visionaries pass over, like will AI reads be part of the professional or technical component of imaging? And what about liability? How many RVUs for an AI read compared to a human one? And how do you get FDA approval on a computer tool that is continuously learning and changing?

 Issues covered in the educational sessions between Dr. Austin and Dr. Dreyer’s presentations only underscored the breadth of topics the RBMA will need to continue to cover, including marketing, leadership development, regulatory concerns and payment reform. Plus, association members were heavily engaged in something AI will never be able to do, coming up with new creative ideas through networking and friendships with other intelligent members of their field.

 As new RBMA executive director Bob Still noted at the Paradigm conference’s networking lunch and awards ceremony, there has never been a better time than now to join the RBMA.

 

 

 


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