A Case Study On Radiology Billing

By Author: Medisys Data Solution Team
Total Articles: 113
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Billing for radiology correctly requires more than just keeping track of money. It is a multi-phase process that necessitates persistently calculating money on each step. Throughout the expanding process, one needs to be tenacious and proactive to ensure collection of every cent which is due.

Unique Challenges—Management and Personnel
Radiologists at a medical setting in Ohio called Medisys Data Solutions into practice because they thought something wasn’t right. They employed a seasoned practice manager who had been with them when their firm commenced a new journey. The practice manager showed very less enthusiasm in taking on any billing responsibilities which kept piling up on the desks. After a while, the group had expanded to include more than 10 radiologists, all of whom expected the practice manager would handle the billing procedures. They lacked the necessary team of motivated employees who were trained in billing procedures, not to mention they lacked certain coding experts and qualifications for the same.

The practice manager was operating a one-man internal billing department, which made things ...
... more difficult in this situation. At Medisys Data Solutions, we immediately noticed that all three of the aforementioned scenarios which were taking place.

Analysis and audit
Following these significant management and staff inefficiencies, our team at Medisys Data solutions highlighted several loopholes which plagued the whole billing system, leading to the majority of the data being erroneous and untrustworthy. Data entry was negligently handled, and there were a haphazardly increasing number of write-offs. We found that in order to hide the significant amounts of money being lost, their billing software was configured to calculate write-offs as contractual adjustments. Other errors and inefficiencies were as follows:

Payment postings were not balanced
Posting partial entries
Stacks of paper checks from previous months were piling up on the desks
Around 6 months’ worth of pending charges
All payments were made on paper with zero track of computerized transactions
The billing team did not follow up with the address denials
Lack of document filing and scanning techniques resulted in no record collections
Days in AR were nearly 100 days
Refunds made in error with sums in excess of mid-six figures
Recommendations and Solutions
Our initial suggestion was to start outsourcing billing operations right away because of the practice’s serious personnel and management issues. The fact that the practice was still unaware of the scope and gravity of their billing issues contributed to the resistance to this notion. As a result, we got qualified managers who were familiar with the current billing system.

The most important advice we gave was to start up a fresh instance of the billing application. Once more, this suggestion was rejected, therefore we were given the duty of overhauling the entire billing system without permission in order to start over with a new billing software or an outsourced billing system.

Most billing companies would throw up their hands in the air and think their options were limited if the main recommendations were rejected. The Medisys Data Solutions team worked numerous hours and through the night over the course of the following six months to restore some normalcy to our client’s invoicing system at Ohio.

Results
Within the first six months, we were able to modify their billing system’s settings such that they complied with RBMA criteria for accounting and classification. This indicated that the new data was entirely reliable and accurate, which represented a sea change for the industry. What came next was a series of modest but effective measures to do away with inefficiencies. Let’s glance through them, shall we?

Scanning and properly archiving all supporting files
Payment reconciliation before posting
Processing reimbursements after evaluating them
Updating hospital admissions made while the billing system was in chaos, along with charges and payments
Using trained coders for coding tasks and implementing PQRS
Medisys Data Solutions served as a consultant on-site for around a year and a half. The group did, however, have one key component that you would anticipate from a practice, which is record keeping. As the old AR was whittled down, the Net Collection Percentage for all tax IDs averaged well over 100%. The entire refund process was redesigned, which resulted in a halving of credit balances.
Wrapping up
It is time to know the income cycle of your radiology practice like never before. You can choose the level of support your office needs from our range of medical billing services for radiology practices, whether you need assistance regularly, occasionally, or occasionally. We are familiar with your industry and are aware of the steps necessary to restore your revenue health and provide you peace of mind.

Our offerings at Medisys Data Solutions looks like this:

Accounting and Receivables Management
Compliance and Coding
Management of Underpayments, Denials, and Appeals
Contract Administration
Collections of Self-Pay and Follow-Up on Insurance
Analytics and Reporting
Services for Practice Management
To enhance processes, boost administrative, financial efficiencies, and enhance clinical decisions, Medisys Data Solutions offers market-leading analytics, extensive data, and unmatched connection and data transfer across providers, payers, and consumers. Utilize the power of the Medisys Data Solutions to hasten the change of healthcare. What are you waiting for? We’re merely one tap away!