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.”

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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Medical Device Amendments to FDA Bill Could Help Imaging Vendors

(Vendor) Permanent link

The House Energy and Commerce Committee has approved two amendments to the Food and Drug Administration Reauthorization Act (FDARA) of 2017 (H.R. 2430) that the Medical Imaging & Technology Alliance (MITA) supports.

The MITA-supported amendments were offered by Reps. Ryan A. Costello (R-PA) and Scott Peters (D-CA). Rep. Costello’s amendment would require the U.S. Food and Drug Administration (FDA) to complete its report to Congress on servicing of medical devices within 180 days. Currently, only medical device service activities performed by a manufacturer are regulated by the FDA, and manufacturers have expressed concern about the lack of oversight and potential patient-safety issues in third-party (non-original equipment manufacturer) servicing of imaging equipment. The Rep. Peters amendment creates a regulatory pathway for new uses of medical imaging devices and contrast agents that have previously been approved by the FDA. MITA says this will help ensure patients have faster accesses to new innovations in imaging.

“MITA applauds the Committee’s efforts to champion reasonable, common-sense solutions to clear regulatory hurdles that hinder medical innovation and ensure consistent regulation of the servicing of medical devices as part of the user-fee agreement,” stated Joe Robinson, chairman of the MITA board of directors and senior vice president of health systems solutions at Philips Healthcare, in a MITA press release. Philips Healthcare is the exclusive imaging equipment partner of the RBMA for 2017.

Two additional amendments would allow the FDA to classify medical device accessories according to the risk posed by the accessory (instead of the risk posed by its parent device) and set up FDA pilot programs for the safety surveillance of certain medical devices once they are on the market. The bill now heads to a floor vote in the House for passage before being sent to the Senate. A vote is expected before the end of June. 


How to Connect with Introverted Customers

(Marketing) Permanent link

Are you unintentionally turning off nearly half of potential new patients? According to Bernardo Carducci, Ph.D., director of the Shyness Research Institute at Indiana University Southeast, about 40 percent of adults describe themselves as shy. Furthermore, he has found that shyness often intensifies during times of stress and transition.

These facts are important for health care marketers to know as it means a significant portion of their potential customers may feel uncomfortable with direct person-to-person interaction. Even if they are normally able to handle asking questions of authority figures, like doctors, or calling an office to book an appointment, when dealing with a stressful medical problem, the effort necessary to overcome natural shyness will be that much greater.

This is where new digital marketing and communication tools can really help. In the May-June RBMA Bulletin Marketing column, Kim Kelley, FRBMA, principal and creative director Ali`i Marketing & Design, reminds readers about the importance of a robust website where current and potential patients can quickly find answers to nearly all questions that may come up without having to make a call and speak with staff.

“Content creation is time-consuming, but well worth the effort,” Kelley writes.

Being able to request an appointment online through your website is also a big help as many shy people prefer this to calling. In addition, many patients prefer live chat to speaking with a staff member, Kelley noted.

Other features customers are becoming used to finding online include links to ask a question, leave a review, go to a company’s social media pages or read its blog. All these are appreciated by introverted patients. In addition, Kelley wrote that downloads from a practice’s site that contain useful, quick-reference information or lengthier service descriptions can be helpful.

Because extroverts tend to excel in marketing, it can be challenging to see the perspective of shy patients. They may appear less engaged because they are less willing to ask questions or call about problems. However, that does not necessarily mean that they are less interested in understanding their care and the tests they need to undergo. The practice that builds up trust and meets their needs with digital communication alternatives to traditional face-to-face or telephone customer service will earn their appreciation and loyalty.

To learn more about connecting with introverts and building trust, read “Should You Market Differently to Introverts” by Maria Watkins, a content manager at California-based Main Path Marketing.  

For great tips for radiology marketers about reaching customers in the age of instant gratification, read Kelly’s column in the current issue of the RBMA Bulletin. Members of the RBMA can access the article online here. (RBMA member login required.)


Know Your 2017 Modifiers: PN, PO and FX

(Coding) Permanent link

Two areas where the Centers for Medicare and Medicaid Services are reducing reimbursement are services provided at certain hospital outpatient departments and imaging that still uses film. However, CMS has no simple way to automatically know which services were performed in hospital outpatient departments that qualify for the cut and which imaging was film-based. Instead, it is counting on coders to tell it which claims need to have the reimbursement reduced through the use of two new modifiers and an existing modifier with a new definition. Meet you PN, PO and FX modifiers. 

“Basically, we have to tell Medicare to pay us less money,” said Melody W. Mulaik MSHS, CRA, FAHRA, RCC, CPC, CPC-H, president of Coding Strategies, during an April 24 presentation at the 2017 RBMA PaRADigm conference in Chicago.

The PN modifier is the first new modifier in the lot. It must now be applied to all non-excepted services provided at an off-campus, outpatient, provider-based department of a hospital and triggers an automatic 50 percent reduction in payment from the ambulatory payment classification (APC). This applies to the technical component of imaging, but not the professional component (the radiologist’s read).

“The 50 percent reduction is somewhat arbitrary, which is why you will probably hear a lot more about this,” Mulaik said.

The second modifier is the PO modifier. It is an existing modifier but has a new definition for 2017 and must now be applied to all claims for services provided at an off-campus, outpatient, provider-based department of a hospital that is exempt from the payment reduction for reasons such as being within 250 of the hospital or being a provider-based department grandfathered in because it began billing services prior to Nov. 2, 2015, when the rule creating the payment reduction was put into place. It is the modifier that needs to be added if you are not using the PN modifier for hospital outpatient department imaging.

The final new modifier is the FX modifier and it must be put on claims for imaging that was film-based and not digital. Nearly all imaging is now digital, of course, but when film is used, this modifier must be added so that the reimbursement on the claim can be automatically reduced 20 percent as required by the Consolidated Appropriations Act of 2016.

More changes are likely coming as CMS moves to reduce reimbursement for computed radiography (CR) by 7 percent starting next year. Guidance for this change is not yet out, but Mulaik’s guess is that it will involve yet another modifier that must be added to claims to signal that payment should be reduced.

The new modifiers and the many other coding related changes coming from CMS highlights why continuing education is so valuable for radiology coders. In 2017, RBMA stepped up to create a special coding education track at the PaRADigm conference in Chicago. Plans are for this to continue in 2018. For more details on coding education resources through the RBMA, visit. from rbma.org/coding

Time to Decide How to Participate in MIPS

(Management) Permanent link

The registration window for groups wishing to participate in the Merit-based Incentive Payment System (MIPS) via the Centers for Medicare and Medicaid Services web interface or the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS survey closes June 30. Should your group register or will you submit data another way? Is it better for your radiologists to participate as a group or as individuals? 

These are tricky questions, especially this early in the process. The system for submitting MIPS data will not even open until Jan. 1, 2018, but because of the registration deadline, now is the time to figure out how you will participate.

On May 22, the Centers for Medicare and Medicaid Services held a webinar to help groups and individual clinicians get ready. Here are highlights of their tips:

  1. In late April or early May, your radiologists should have received a letter from CMS letting them know if they are considered eligible for inclusion under MIPS or not. If they are eligible, it is imperative to participate as non-participation will lead to a 4 percent payment reduction. If you did not see the letter for every clinician in your practice, you can also look them up by their national provider identifier numbers here. Note, if not every radiologist in your practice is eligible but you participate as a group, you still need to report group-level data from those non-eligible radiologists.
  2. Review your practice’s readiness and ability to report. This may include working with your vendors.
  3. Go to the CMS Quality Payment Program website to see the different “pick your pace” options. If you are not ready to report fully, you can still report partial data for less than a year to avoid the 4 percent payment reduction.
  4. Decide if you want to submit data by individual radiologist or if you will submit group-level data. For radiology groups, an added consideration is how many of the radiologists in the group will count as “non-patient facing.” The reporting requirements are quite a bit easier for non-patient facing clinicians and groups. To report as a non-patient facing group, more than 75 percent of your radiologists must count as non-patient facing clinicians. If you have three radiologists in your practice and one of the three counts as being a patient-facing clinician, your whole group would count as patient-facing.
  5. Choose your submission method and verify its capabilities. As noted above, if you will be submitting data as a group by web interface or through the CAHPS for MIPS survey, you must register by June 30. (Practices that already registered for the Group Practices Reporting Option in 2016 are automatically registered.)
  6. Verify your EHR vendor or registry’s capabilities before your chosen reporting period.
  7. Carefully browse the list of measures you can report on that is posted on the Quality Payment Program website. CMS recommends reviewing your current billing codes and Quality Resource Use Report to pick the measures that will be easiest for your practice to report.

Remember, the data submission period will run from Jan. 1 to March 31 in 2018. To learn more about MIPS participation and get answers to questions from fellow RBMA members through the rest of the year, consider joining the RBMA Practice Management and Coding forums. These are exclusive benefits for RBMA members. Learn more here.  

Healthcare Payment Changes Move to States and Agencies as Congress Gridlocks

(Leadership) Permanent link

As Senate Republicans work to craft a version of the House-passed American Health Care Act (AHCA) that can attract support from at least 50 of the 52 Republicans in the Senate before a self-imposed end of June deadline, there is growing doubt that a repeal and replacement of the Affordable Care Act will happen this summer. With Congress gridlocked, more of the health care payment reform issues that could impact radiology business could come from state legislatures, federal agencies and even private payors. Here is a roundup of some of the issues to watch:

Digital Breast Tomosynthesis (DBT): Six states have moved to require private insurance coverage of DBT and Texas may soon become the seventh. Texas Governor Greg Abbott has only a few days left to sign or veto House Bill 1037, a mandated coverage requirement that received legislative approval May 30, or it will become law without his signature. Although 32 states now require dense breast tissue reporting, only Kansas, Connecticut, Illinois, Maryland, New Jersey and Pennsylvania currently require private insurance DBT coverage. DBT coverage legislation is pending in Massachusetts, New Hampshire, New York and Ohio.

CT Colonography: In April, Aetna became the last of the nation’s five largest insurers to cover screening CT colonography, sometimes called virtual colonoscopy, without a patient copay. Last year, the U.S. Preventive Services Task Force rated the test an “A,” its highest rating, for individual between 50 and 75 years of age. The Affordable Care Act requires private insurance companies to cover screening studies approved by the USPSTF without patient cost sharing. Some smaller insurers still do not cover the test, but the American College of Radiology Colon Cancer Committee is working with commercial insurers on compliance with the ACA and seeking to get Medicare to cover the exam.

HHS Budget Cuts: Even if Congress does not pass the AHCA, it could still cut Medicaid by trimming the amount of money sent to states for the program. In June, Health and Human Services Secretary Tom Price, M.D., testified before the Senate Committee on Finance and the House Ways and Means Committee on the Trump Administration’s 2018 “skinny” budget, which would cut $665 million from HHS, mostly by reducing the amount spent on federal support for Medicaid. Should the cuts happen, it would constrain even further what states can reimburse for imaging for Medicaid patients.

RVU Re-Evaluation: According to a new study published in the Journal of the American College of Radiology, the method used by the Medicare Payment Advisory Commission’s Relative Assessment Workgroup to find potentially misvalued codes may disproportionately single out imaging codes. The study’s review of the CMS Requests and Relativity Assessment Issues Status Report found that 46 percent of diagnostic imaging exams were flagged for review, compared to 22 percent of all remaining codes. Because the re-evaluation of relative value units (RVUs) for potentially misvalued codes tends to result in a reduction in RVUs for the code, this adds further downward pressure on radiology reimbursement on the regulatory side.

Keeping an eye on so many potential fronts for radiology reimbursement changes can be challenging, but participation in the RBMA can help. The RBMA Federal Affairs Committee is stepping up its activity this year and has partnered with the RBMA Programs Committee and RBMA Board to create the first RB<A Legislative Education and Regulatory News (LEARN) two-day seminar in McLean, Virginia, just outside Washington, D.C. The seminar will be held Sept. 10 to 11 and will be followed by an optional lobbying day on Sep. 12 where attendees will visit the Capitol Hill offices of their elected representatives and senators to help inform them about the many business issues radiology practices face. 

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.


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