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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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.

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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Imaging Technology Companies Report Early Positive Impact of Device Tax Suspension

(Vendor) Permanent link
When the Affordable Care Act established a new medical device tax to help pay for coverage expansion, imaging technology companies that were primarily impacted by the tax had little room to pass the cost of the new tax on to their customers. Imaging reimbursement had been cut 14 times since 2006 making it tough for vendors to charge radiology practices more. In addition, the promised new influx of ACA-covered patients that was supposed to help offset the cost of the tax also did not materialize.

Instead, developers of advanced imaging technologies say they cut staff, research and development budgets. Now that the device tax has been suspended for two years, they say they are putting that money back in. According to a survey of Medical Imaging Technology Alliance members conducted from April 21 through June 24, 2016, nearly 76.9 percent of respondents said they are either definitely or probably investing additional resources in research and development projects. Furthermore, 69.3 percent of respondents indicated they would be either extremely or somewhat likely to hire more employees. (The mean number for hires was 99 people with 100 percent of those being U.S. hires.)

For anyone interested in better patient care through more advanced imaging options and a stronger U.S. economy, this is good news, and MITA clearly hopes legislators will remember this when they consider whether to make the tax break permanent. But there was some important good news specifically for purchasers of imaging technologies, like RBMA member practices. Nearly 70 percent of the survey respondents indicated they were likely to invest in new infrastructure to introduce manufacturing efficiencies that could lower they cost of their products. In the free text fields of the survey, respondents also indicated they planned to hire more sales staff (better customer service) and one company said it hoped to lower prices for its products and service contracts.

“These survey findings confirm that suspension of the medical device tax has already helped boost investment in R&D and ignite medical technology innovation in just a few months,” stated MITA Board Chairman Nelson Mendes, president and CEO of Ziehm Imaging Inc, in a press release announcing the survey. “Full repeal of this burdensome tax will turn yesterday’s economic headwinds into tomorrow’s tailwinds, spurring sustained growth and protecting patient care. We appreciate the bipartisan efforts of Congress to address this tax and urge them to vote for full repeal when the time comes.”

Do you think the two-year suspension of the device tax could benefit your radiology practice? Please share your thoughts in the comments.

Tips for Marketing a Move

(Marketing) Permanent link
Getting the word out about a new location or the move of an existing location ensures your patients, referral sources and other stakeholders are not lost in the process. Kim Kelley, FRBMA, principal and creative director of Ali`i Marketing & Design has helped many practices develop marketing plans for moves. She says that as soon as you have a date for the relocation or new site opening, it is wise to start planning how to market your move.

Developing a relocation announcement and coordinating with your graphic designer and printer on signs and flyers is really on the beginning in today’s digital age. Every practice, even the ones with just the simplest of websites, has an online presence. Kelly advises practices to work with their website developers and social media persons on the marketing of the move.

Also consider other important places online where your address is listed that you do not control directly, such as Google and Apple maps, Healthgrades and Yelp. Invest some time in Googling your practice as if you were a patient and become familiar with how to submit an updated address (and phone if applicable) to the important places your patients may find your contact information online.

“If you participate with reputable directories, make sure they get the information too,” Kelly notes.

Moves are expensive, so there is a temptation to try to control costs and limit what is spent on marketing the move. However, since your practice will already be incurring costs related to website updates, signage, flyers, new business cards, press releases and much more, view a move as an opportunity to maximize marketing of other changes you may wish to make.

Kelly notes that a move is actually a perfect opportunity for updating your website and logo or even a complete rebranding because you are already updating and replacing a great deal of your existing marketing materials for the move.

“Do not be cheap where it matters,” she writes. “Your audience is online and you need your announcement to be out in the open where they can see it. If your website needs an overhaul, consider having a new one designed and developed. It would not be wise to make a big deal of your changes and improvements but let your old, outdated website continue to represent your business.”

For all of Kelly’s tips, check out the May-June issue of the RBMA Bulletin, available online exclusively to RBMA members here.

Tips for Using E/M Codes in the ED

(Coding) Permanent link
Evaluation and management (E/M) codes can prove enticing to radiologists as they seem to offer an opportunity to obtain some small measure of fair compensation for the free consulting work radiologists regularly do for their hospitals. However, be cautious. A scenario recently came up on the RBMA coding forum that offered some valuable insights.

A patient presented in a hospital emergency department with severe back pain. The x-ray showed an L5 compression fracture, and the ED physician asked the interventional radiologist to consult. The interventional radiologist examined the patient, reviewed the findings and developed the treatment plan. It would seem fair that the radiologist should then get to bill the appropriate E/M codes.

According to Centers for Medicare & Medicaid Services’ Medicare Learning Network (MLN) issue number MM6740, it is permitted for a radiologist such as the one in this case to bill an E/M code even though the ED physician already examined the patient. The key criteria is that the ED physician requested that another physician evaluate the patient and that there was medical need for the second evaluation. Many types of helpful consultation that radiologists provide at hospitals are certainly valuable and help cement a strong relationship between the radiology group and the hospital physicians. However, not all rise to the level of being medically necessary in the view of CMS and its administrative contractors. For example, a phone consultation cannot be billed. That is considered part of the service for reading an image.

Jeff Majchrzak, BA, CIRCC, RCC, 
vice president of Clinical Consulting Services – Radiology for Panacea Healthcare Solutions, Inc., offered advice on the forum. According to Maichrzak, to bill E/M codes, the interventional radiologist must have performed all the components of an E/M service (history, examination and medical decision making). In addition, the type of E/M visit that should be billed depends on who admitted the patient to the hospital.

“If the interventional radiologist only consulted and did not admit the patient, assign an outpatient consultation or emergency department E/M code,” Majcrzak wrote. “The appropriate code is based on the payer guidelines and the provider’s documentation. Physician E/M codes are based on the location in which the service was provided. Consultation documentation must include the requesting provider, reason for consultation and, if not a shared record, a report back to the requesting provider. If the payer, such as Medicare, does not recognize consultation codes submit the appropriate emergency department E/M code. If the IR MD or a member of the group admitted the patient submit the appropriate inpatient admission code.”

Coding advice is regularly shared on the RBMA Coding Forum, an exclusive benefit for members. Learn more about the RBMA online forums here.

Joint Commission Change on CT Technologist Requirements Eases HR Concerns

(Management) Permanent link
More important than any other resource, the right staff with the right training can be vital to a practice’s success. Attracting and retaining the most highly trained radiologists, technologists and operational staff, particularly in a rural setting where salaries may be lower, is a constant practice management challenge. Earlier this year, that challenge looked to become even tougher as the Joint Commission created more stringent training requirements for CT technologists at its accredited hospitals and ambulatory care organizations that provide diagnostic imaging services.

Rural and critical access hospitals in particular reached out to the Joint Commission to advocate for a reversal of the change, and last month, the Joint Commission agreed, noting that concerns about these hospitals’ ability of comply with the new requirements and the potential negative impact of this on patient access to CT imaging were factors in its decision.

According to the Joint Commission, it will no longer require that CT technologists at its accredited hospitals or ambulatory care organizations (including those that have achieved Advanced Diagnostic Imaging certification) obtain advanced-level CT certification from the American Registry of Radiologic Technologists (ARRT) or the Nuclear Medicine Technology Certification Board (NMTCB) by January 1, 2018.

The Joint Commission still encourages obtaining such advanced certifications and ongoing training and education of technologists is still a requirement. However, it is no longer making an advanced-level CT certification a requirement for all starting in 2018.

“You shared your concerns, we listened, and made changes,” wrote Joyce Webb, project director for Standards and Survey Methods at the Joint Commission, on the accrediting body’s blog.

Practice managers at Joint Commission accredited organizations should note that technologists are still expected to have the appropriate state licensure for performing diagnostic CT exams and documented training on the provision of diagnostic CT exams. Alternatively, they can also be registered and certified in radiography by the ARRT or in nuclear medicine technology by the ARRT or the NMTCB.

ARRT certification exams run between $200 and $400, while NMTCB runs between $180 and $360. Some radiology practices offer financial support for employees seeking advanced certifications within certain limits. For example, if the employee fails to pass the certification exam, he or she may need to personally pay to take it a second time. Practices also sometimes require employees to refund a portion of the cost of the certification if they resign shortly after having become certified. What is your practice’s policy on reimbursing technologists for training and certification costs? Please share in the comments.

RBMA Joins ACR, AQI and MedQuest in Advocating for LDCT Lung Cancer Screening at IDTFs

(Leadership) Permanent link
Since coverage for low-dose CT (LDCT) lung cancer screening exams was extended to Medicare beneficiaries in late 2014, the Centers for Medicare and Medicaid Services (CMS) and its administrative contractors have exercised caution in order to try to ensure the test is not overutilized. Regulations prevent any type of direct solicitation of patients and require the LDCT provider to be part of an approved registry.

Although these would seem to be sufficient safeguards, CMS recently issued an interpretation of its regulations found at 42 CFR §410.33(g)(7) that says independent diagnostic testing facilities (IDTFs) cannot perform LDCT lung cancer screening tests because these are screening tests and not diagnostic tests.

Notably, CMS has not now nor previously expressed any concerns about the safety of CT imaging in the IDTF setting and the interpretation seems at odds with both existing practices and federal health policy, which is encouraging more imaging to be done in the IDTF setting, not less.

RBMA, along with the Association for Quality Imaging (AQI) and MedQuest Associates, has joined an ACR letter to Tamara S. Syrek Jensen, J.D., director of CMS’s Coverage and Analysis Group. In the letter, William T. Thorwarth, Jr., M.D., FACR, CEO of the ACR, notes that IDTFs are already permitted to perform other types of screening services, including abdominal aortic aneurysm ultrasound screening (AAA ultrasound) and screening mammography. In addition, they also offer CT exams that are similar in nature to LDCT lung cancer screening, such as CT colonography and non-contrast chest CT exams.

“We urge CMS to accept the logic that those procedures — like LDCT — that have a reasonable nexus with ‘diagnostic testing’ should be within the scope of the services that IDTFs are permitted to perform,” Dr. Thorwarth wrote.

How likely patients are to adhere to screening test recommendations depends a great deal on how easy the test is to get, which is why the RBMA shares the concerns of ACR, AQI and MedQuest that CMS has moved to further restrict the types of sites where the test may be offered.

“CMS has the authority and opportunity to impact screening rates and save lives,” Dr. Thorwarth noted.

Should CMS not heed the Dr. Thorwarth’s warning, it could get in hot water with legislators and patient advocates that clearly want more access to testing rather than less. In May the Lung Cancer Alliance, a patient advocacy group, succeeded in getting bi-partisan legislation introduced in both houses of Congress that would instruct the Department of Health and Human Services, the Department of Defense and the Veterans’ Administration to develop a national lung cancer screening strategy that would expand access to potential underserved populations, such as women and those with genetic markers like the BRCA 2 mutation that put them at higher risk for developing cancer.

The Senate version of the Women and Lung Cancer Research and Preventive Services Act of 2016 is S. 2941. The House version is H.R. 5263.

Stand-alone bills like these are unlikely to pass, especially in an election year, but they offer an opportunity for legislators to go on record with where they stand on an issue. To see if your Congressional representatives have signed on, look up the bills on https://www.govtrack.us.

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. 

  

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