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.”

More Resources For Practice Leaders:

Resources For Leaders

Register now for DataMAXX for reliable and immediate data to make the right operational decisions, optimize resources, continuously improve performance and develop a strategy for the future

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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.”

More Resources For Managers:

Conference Audio Recording

Articles

Resources For Managers

DataMAXX

RBMA U

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.

DataMAXX

DataMAXX

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.”

More Resources For Practice Coders:

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.”

More Resources For Practice Vendors:

Resources For Vendors

Start planning your 2017 marketing program with RBMA today! Consider a Global Level Sponsorship. Contact daphne.gawronhski@rbma.org for details.

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Enhance your RBMA presence, increase brand awareness, and solidify your position in the industry through a variety of sponsorship programs

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A New Point of View at PaRADigm

(PaRADigm) Permanent link

Radiology is a resource- and technology-intensive field that also has one of the best potentials for reducing overall health care costs through better disease detection and faster, more accurate treatment. This yin and yang of radiology, both a cost driver and a cost saver, puts it at the very center or efforts to transform U.S. health care into a more sustainable system.

Of course, being the center or change is more than a bit scary. At the first RBMA PaRADigm conference keynote presentation on Sunday, April 23, Mark Sanborn, an economist, author and noted expert on leadership, team building, customer service and change, encouraged attendees to shift their perspective on change. Instead of asking what will happen, ask what can you make happen, he counseled. Instead of asking how you can manage change, ask how you can lead change.

“I want to expand your thinking about what you are capable of,” he said.

Big changes are indeed coming. In the general session later that same day, James Brink, M.D., chair of the American College of Radiology, shared three key drivers of change for radiology over the next five years. According to Dr. Brink, physician payment reform (including the Quality Payment Program), population health management, and artificial intelligence and machine learning have the potential to revolutionize the field. Already, algorithms exist to analyze medical images and make highly accurate assessment of things like determining bone age in pediatric patients. More complex artificial intelligence assessments are not far away, and this new technology will change the role of the radiologist and accelerate the drive to reduce variation in everything from protocols to radiologist reporting and recommendations.

Of course as these things change, so will the role of the radiology business manager. The RBMA Board of Directors and new Executive Director Bob Still, are implementing changes to ensure the RBMA remains relevant and growing along with the field. Bob Still is conducting a listening tour at the first PaRADigm conference to see how RBMA could shift its own paradigm to help members succeed in meaningful ways.

Sanborn, Still and Dr. Brink all explained in their own ways that leading change means asking the right questions -- and over the next few days, Still plans to speak with as many attendees as he can to ask variations on four key questions:

  1. How do you see RBMA being successful?
  2. What would make it successful for you?
  3. How will we know it is successful?
  4. What would your focus be if you were the new executive director?

If you are following along with the events at the conference here on our daily blog, but are not here in person, please share your thoughts on these questions in the comments.

 

 

 

What Marketers Need to Know About Quality Reporting

(Marketing) Permanent link

With 2017 being the first year of measurement for the new Merit-based Incentive Payment System, quality reporting and value-based payments are an even hotter topic, and for good reason. Out of the four domains that figure into whether a practice or group will get paid an incentive payment under MIPS, quality is 60 percent of the score in the first year of the program.

However, marketers do not influence clinical quality. Why do they need to care about quality reporting?

The answer lies in what happens to the quality data reported to the Centers for Medicare and Medicaid Services after it is used to determine Medicare payment under MIPS. Marketers should understand that the government’s goal is bigger than simply rewarding physicians for delivering higher quality care. CMS also wants to give patients more reliable information about the relative quality of different physicians and medical groups so that these patients can shop around for the best care. The idea is that making quality information easy to the public to access will encourage consumer-driven, not just payor-driven, improvements in care.

Six years ago, CMS launched its Physician Compare website. It was not much at first. The data came from the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and included little more than a physician’s name and address. However, since the launch, CMS has been adding to the information on the site using the quality data it has gathered through the Physician Quality Reporting System (now the quality dimension of MIPS).

Physicians who have reported quality data through PQRS are assigned a star rating by the site. One star is the lowest rating and five stars is the highest. In addition, CMS makes all of the quality source data public to encourage other private physician rating sites, such as Healthgrades.com or Vitals.com, to also begin to incorporate CMS quality data into their physician rating systems.

Of course, the measures physicians in specialties like radiology report on do not always translate easily into a selling point for a potential patient. For example, a radiologist who reads mammograms will get a star rating on Physician Compare for “categorizing X-ray images in breast cancer screening.” Only if a patient clicks on a plus button next to the star rating do they get any more information about the measure, and even that information is very brief.

However, star ratings are easy to understand. If you have a choice between a three-star or a four-star restaurant or hotel and the price is the same, you will pick the one with more stars. Patients will likely do the same when picking a doctor. 

Because Medicare star ratings of physicians are fairly new, marketing efforts so far have not touted physician ratings. But greater patient use of the data and a corresponding need for marketers to address this may mean that the Medicare star ratings become a bigger concern for marketers in the future.

If your job involves marketing your radiology practice and you’ve not yet checked our how your doctors appear on CMS’s Physician Compare site, now may be the time to look them up. With MIPS payments starting in 2018, quality reporting will soon be coming to every practice and more quality data on all doctors, including radiologists, will become available to the public. 


Paradigm Features Coding Education Track

(Coding) Permanent link

Although coders are among a billing operation’s most expensive hourly employees, the value of coders and the need for them to engage in continuing education often goes unappreciated writes RBMA Board of Directors member Patricia Kroken, FACMPE, CRA, FRBMA, in the latest issue of the RBMA Bulletin. The RBMA has a strong resource for coders in its online coding forum, but the Board and the RBMA Coding Subcommittee recognized that there was a need to improve its continuing education offerings for Radiology Coding Certification Board (RCCB) certified coders, explains Lori Shore, the subcommittee’s chair.

With the encouragement of the Board and working with the RBMA Programs Committee, the Coding subcommittee helped develop a special coding education track for the Association’s first Paradigm conference in Chicago. Attending every session in the track will earn the attendee five continuing education credits, as well as some very useful career-enhancing information. The presentations cover topics from structured reporting for Merit-based Incentive Payment System quality measures to interventional radiology coding and the ins and outs of evaluation and management (E/M) coding.

“I am very excited because we have some of the top experts in coding education presenting at Paradigm,” Shore said. “It was truly a team effort to attract this level of expertise and talent, and I am so grateful to the other members of the Coding Subcommittee for putting in the work to make this happen.”

The coding presenters for the 2017 Paradigm conference in Chicago include:  

  • Jennifer Bash, RHIA, CPC, CIRCC, RCC, coding and documentation education manager for ADVOCATE Radiology Billing, is a member of the American Health Information Management Association (AHIMA) and the American Association of Professional Coders (AAPC). She is an AHIMA-Approved ICD-10-CM trainer with nearly 15 years of radiology coding experience.  
  • Stephanie Dybul, MBA, RT (R)(VI), CIRCC, division administrator of vascular and interventional radiology with The Medical College of Wisconsin, has served on the RBMA’s Coding Subcommittee since 2013. In addition, she is an active volunteer within the Society of Interventional Radiology and serves on numerous SIR committees including its Coding Education and Application Workgroup.  
  • Catherine Everett, MD, MBA, president and managing partner at Coastal Radiology, is a radiologist and the first and only woman to have served as Chief of Staff at CarolinaEast Medical Center.  
  • Debby Mann, CPC, RCC, ROCC, coding documentation and education manager at ADVOCATE Radiology Billing and Reimbursement Specialists, has more than two decades of radiology billing experience. She is a member of the RBMA Coding Subcommittee and Programs Committee. She holds many coding certifications and is an AHIMA-approved ICD-10-CM and ICD-10-PCS trainer. 
  • Karna Morrow is the manager of consulting services at Coding Strategies, Inc. 
  • Melody W. Mulaik, MSHS, CRA, CPC, CPC-H, RCC, is president and founder of Coding Strategies, Inc. and Revenue Cycle, Inc.  

Paradigm takes place April 23 to 26. In addition, some sessions will be available to attendees as audio and slide presentations after the conference. To learn more about the coding track at the RBMA Paradigm conference, visit: http://www.rbma.org/RBMA_PaRADigm_Coding/. 


Don’t Waste Your MIPS Learning Year

(Management) Permanent link

This is the first year that the Centers for Medicare and Medicaid Services will collect data to determine future reimbursement for practices on the Merit-based Incentive Payment System track of the new Quality Payment Program. CMS seems to be genuinely trying to go easy on practices just getting accustomed to the new system. According to its own Quality Payment Program website, practices that submit just 90 days of data or partial measures, are still protected from a cut and may even receive as much as a boost to their Medicare payments in 2019. Furthermore, a practice that submits a full year of data is guaranteed a positive payment adjustment in 2019.

It also helps that while CMS is collecting cost data from claims, it is not yet grading practices on this measure. Plus, the Advancing Care Information measure that patient-facing practices must worry about is not counted in for most non-patient-facing practices, which includes the majority of radiology practices. (Click here to go to the Harvey L. Neiman Health Policy Institute patient-facing dataset to check if your practice will count as patient facing.) 

That leaves only two measures that most radiology practices need to worry about: Quality (formerly the Physician Quality Reporting System) and Practice Improvement. The later is a brand new measure designed to reward practices that engage in various activities CMS would like to encourage but which are not rewarded elsewhere.

What counts as Practice Improvement for a radiology practice was the subject of some discussion on the RBMA’s practice management email forum this month. The ACR is still in the process of building its MIPS calculator, but the CMS website offers a smorgasbord of suggestions to sort through in the meantime. The CMS list includes everything from participation in a qualified clinical data registry and using decision support tools to administering safety surveys and training staff in formal quality improvement systems (e.g., Lean methodologies).

It can all be a bit confusing and practices may wonder if the cost of trying to report Practice Improvement activities (which for now are mostly outside other reporting practices need to do) is even worth it. Practice Improvement is not weighted as high as Quality in the overall MIPS calculation, but if one views 2017 as a learning year, taking the reporting seriously makes sense. After all, it is very unlikely CMS will become more lenient on MIPS measures than this year. Rather, it will continue to move up the goal posts as practices become accustomed to the system and better at reporting. Those practices who do not use 2017 as a learning year may be starting further from the goal in terms of knowledge and reporting capabilities in 2018. 

Please watch the “Let’s Talk” blog for more MIPS and the Medicare Access and CHIP Reauthorization Act (MACRA) news from the Paradigm conference in Chicago. Paradigm sessions focused on these topics include:

  • Tackling MIPS Through Structured Reporting with Catherine J. Everett, MD, MBA, from 3 to 4 p.m. on Sunday, April 25.
  • Demonstrating Value in Radiology: MACRA and Beyond with Lisa Mead from 1 to 2 p.m. on Monday, April 26.

Learn more about Paradigm here.  

Fall is a Great Time to Visit D.C.

(Leadership) Permanent link

Through the president’s first budget and the statements of Congressional leaders, it is clear that reducing federal government spending is high on the priority list for the Republican-led U.S. Congress and President Trump’s Administration. But belt-tightening in government does not operate the same way that it does in business. Elected officials also have a crucial additional consideration – the political cost of each cut. This means that the cuts that are easiest to make are not always the ones that make the most logical or strategic sense. They are the ones without strong advocates for protecting that funding.

Radiology learned that lesson first-hand through more than a dozen cuts to imaging spending in the early 2000s. It is now keeping a close eye on developments to hopefully head off future cuts before they are implemented.

One potential place where cuts could come is for mammography studies. The Centers for Medicare and Medicaid Services (CMS) is engaged in updating coding to bundle computer-aided detection (CAD) with mammography services. However, it has not yet opted to use the three new 2017 Current Procedural Terminology (CPT®) codes (77065, 77066 and 77067) or update the technical component relative value units for these services. When it does, it could yield a technical component payment cut as high as 50 percent, according to the American College of Radiology.

The ACR is proactively working with CMS on the issue and has issued a call for additional information to support the ACR in advising CMS on the Medicare Physician Fee Schedule proposed rule for 2018. Specifically, the ACR is looking for practice level data on what a 50 percent cut to the technical component of mammography services would mean for a radiology businesses and patients. Read the ACR statement here.  

What all this means is that September is likely to be a great time to head to Washington, D.C. Visiting the Capitol Hill offices of elected officials personally shows Senators and Representatives how important an issue is to your practice.

To make visiting easy, RBMA will be there to support you. On September 10 and 11, the RBMA is holding a first-of-its-kind two-day Legislative Education and Regulatory News conference at the Ritz Carlton in Mclean, Va. This will be followed by a 2017 RBMA Hill Day on Tuesday, September 12 with transportation and advocacy training provided to attendees to help them make a strong case for radiology with their elected officials. Registration information is available here. Hope we see you in D.C. this Fall!


GOP Plans for Federal Health Spending Would Impact RBMA Members

(Leadership) Permanent link

The American Health Care Act (AHCA) and the president’s 2017 budget, together signal that conservatives want the Federal government to reduce its role in social welfare spending, bring down the deficit, lower taxes and take an overall smaller role in both domestic governance and international influence. Discretionary spending on arts, the sciences and the environment is also sharply cut. 

It is uncertain whether the GOP will be able to muster the votes necessary to pass the AHCA as a start in the repeal and replacement of the Affordable Care Act. In addition, the president’s budget will need to be adjusted considerably in Congress if it is to have any chance of passing because its many spending cuts simply impact too many constituents. However, the overall intention to roll back spending on almost all government programs outside of defense will certainly be a prominent part of federal bills and budgets going forward.

Among the medical specialties, radiology is arguably among the most experienced in what across-the-board federal spending cuts can mean. It survived the arbitrary reimbursement cuts triggered by the Deficit Reduction Act of 2005 and sequestration. It also holds the dubious record of having endured one of the longest strings of continuous cuts (more than a dozen) in Medicare payments.

RBMA members are experienced in rolling up their sleeves and finding new practice efficiencies to help offset a significantly tighter reimbursement environment. However, now that practices already run very lean, it will certainly be a considerable challenge to try to find further savings.

The American College of Radiology, the RBMA and other organized radiology groups are watching developments closely. Experience shows that cuts tend to fall the most heavily on those who do not have a voice in Washington.

In addition to direct reimbursement cuts, some of the ways RBMA member practices could be impacted may include:

  • An increase in bad debt from caring for uninsured patients. The Congressional Budget Office estimates that under the AHCA, 24 million Americans would lose health coverage.
  • A decrease in overall patient volume, especially for preventive screenings that patients may believe are no longer covered.
  • Less funding for research grants.
  • Greater difficulty in attracting top radiologists to positions, especially as foreign medical students and researchers look for better opportunities in other countries.

RBMA members have access to the weekly RBMA Washington Insider electronic newsletter, which covers both what is happening with the AHCA and with other significant health bills and regulatory changes that can get lost among the headlines covering the bigger issues. Members also get e-Alerts when there is breaking health policy news. In addition, the ACR’s Advocacy in Action eNews is updated weekly and is available free to the public at acr.org/Advocacy/eNews.

Finally, Ted Burnes, executive director of RADPAC, the radiology political action committee, will be at the RBMA PaRADigm conference April 23 to 26 in Chicago to give an update on health policy developments. Visit rbma.org/paradigm to learn more. 

Coders Turn to Peers for Guidance in Billing Unusual Treatments and Services

(Coding) Permanent link

The world of medical research is one of innovation, imagination and infinite possibilities. The world of medical coding isn’t. Coding exists to bring structure and order to the art and science of medicine. To clearly define situations by what they are and are not so that they can be reimbursed fairly and efficiently. 

Occasionally, these two worlds collide. When an ordering physician faced with an unusual medical problem decides on an unorthodox (but research-informed) combination of tests or treatments, this can present quite a challenge for the coder. It is at times such as these that communities of coders, like the RBMA’s Coding Forum, really prove their value.

The RBMA Coding Forum has seen questions ranging across a broad gamut, including how to code and bill imaging done on conjoined twins. Recently, a member asked if it is possible to bill for a radiology department’s part in fecal transplant procedures.

Although once rare, fecal microbiota transplants (FMT), as they are officially known, are now done at hospitals across the nation. Research findings support that FMT is effective in the treatment of C. difficile infection, and it is now being studied as a possible treatment for many other conditions, including diabetes, ulcerative colitis and even autism. 

Still, the treatment is new and not officially approved by the U.S. Food and Drug Administration. The FDA allows its use under its investigational new drug guidelines and a 2013 special guidance for the treatment of C. difficile in patients who have tried the standard therapies without result.

There is also no one standard way to perform a FMT, with multiple ways of administering the fecal microbiota from the donor in use. One of those ways is through a nasogastric tube, which is how the Coding Forum member’s hospital radiology department became involved.

FMT patients would check into the Endoscopy Department and then be sent to the Radiology Department for placement of the NG tube with fluoroscopic guidance. But there is no official protocol for how to code such situations, and even the American Gastroenterological Association is at a bit of a loss. It recommends 44799, the code for unspecified procedure lower intestine, for situations where donor microbiota is administered by either oro-nasogastric tube or enema. Of course, payers sometimes will not accept unspecified codes. In addition, Medicare does not pay a separate fee for installing microbiota by NG tube, according to the American Gastroenterological Association.  

However, there is one possible solution for departments doing a large enough volume of NG tube placements for FMT that the cost of this unreimbursed care becomes a concern. In Medicare patients, gastroenterologists will sometimes require patients to sign an Advanced Beneficiary Notice form to alert them that part of their treatment will likely not be covered by Medicare and that they will need to be responsible for paying this cost. The ABN is usually sought because Medicare does not cover the costs of screening donor fecal specimens for FMT. However, it could be adjusted to also address other areas of unreimbursed care in an FMT, including the Radiology Department’s work.

Have you encountered an unusual coding situation that left you perplexed? Does your hospital department place NG tubes for FMT or perform other more unusual procedures? Your peers on the RBMA Coding Forum may be able to help. The RBMA’s forums are exclusive benefits for RBMA members. Learn more at rbma.org/RBMA_Forums/.

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