RCM for Radiology: 21 Tactics to Optimize Revenue

Radiology communications repair tactic #2: integrate technology

Radiology practices leverage these technology platforms to improve communication: 

• Picture archiving and communication systems (PACS) with instant messaging functions to facilitate real-time communication with referring physicians.
• Digital Platforms: Use digital platforms that allow for real-time communication between radiologists and referring physicians. Tools like zero-footprint viewers can facilitate immediate access to patient images and reports. 
• Electronic Referral Systems: Adopt electronic referral systems to reduce errors and delays associated with manual processes. This can help ensure that all necessary patient information and orders are accurately transmitted.
• Automated Reminders: Use automated reminders to keep referring physicians informed about upcoming appointments and any necessary actions, enhancing patient care continuity.
• Radiology information systems (RIS): RIS systems facilitate communication and collaboration among radiologists and other healthcare professionals. They enable secure exchange of patient data, real-time messaging, and remote access to reports.
• Mobile apps: Mobile apps like Rad Results provide a direct line of communication between radiologists and the patient care team. These apps allow for real-time alerts and notifications when reports are available or when critical findings are identified, ensuring timely communication and collaboration.
• Electronic Health Records (EHRs): EHRs can be integrated with radiology systems to ensure that imaging reports are accessible within a patient's comprehensive medical record. This integration facilitates timely access to imaging results for referring physicians and other healthcare providers.
• Cloud-based imaging solutions: These solutions provide fast and secure access to radiological data, allowing healthcare professionals to share images and reports directly with specialists via secure messaging features. 
• Health portals: Patient and provider portals can centralize patient data from multiple medical applications and include secure messaging and report sharing, enhancing communication between radiologists and referring providers.
• Telehealth platforms: Telehealth platforms support virtual consultations and remote discussions, which are particularly valuable in situations where face-to-face interactions are not feasible. This technology allows radiologists to engage more actively with patients and other healthcare providers, improving communication and patient care.

Radiology communications repair tactic #3: Multidisciplinary meetings

By fostering open communication among team members, multi-disciplinary meetings ensure that everyone is aligned on the patient's condition and treatment strategy, reducing errors and improving the efficiency of care delivery.

Radiology communications repair tactic #4: Staff training and education

Training helps radiologists articulate their findings in a way that is actionable and understandable to other healthcare professionals, leading to better-informed clinical decisions and improved patient outcomes. Further, communication training helps minimize errors and misunderstandings. By learning how to structure reports and verbal communications effectively, radiologists can reduce the risk of misinterpretation, ensuring that all team members are aligned on patient care strategies.

Effective communication in radiology is pivotal for reducing billing errors, enhancing patient experience, and fostering strong relationships with healthcare providers. The reputation of radiology practices depends on it. 

Radiology coding repair tactic #1: Comprehensive documentation

Comprehensive documentation provides coders with the necessary information to assign correct codes, reducing the likelihood of errors and claim rejections. This solution means you and your team must:

• document all procedures and treatments in detail.
• record any complications or follow-up visits.
• note all equipment used. 

Orthopedics coding repair tactic #2: Find specialized coding staff

Investing in specialized orthopedic coders or partnering with experienced RCM providers can improve coding accuracy. Ensure those coders are: 

• experts in ICD-10, CPT, and HCPCS coding standards
• employed by a company that provides ongoing professional training. Coders must always stay updated with the latest guidelines. 

Orthopedics coding repair tactic #3: Utilize current coding systems

Staying current with coding systems is essential for accurate billing. Make sure you are:

• using the latest ICD-10, CPT, and HCPCS codes for all orthopedic procedures.
• regularly updating coding software and resources.
• monitoring changes in coding requirements, such as new CPT codes introduced for specific procedures. 

Orthopedics coding repair tactic #4: Regular audits and compliance checks

Conduct internal audits and compliance checks to identify and correct coding errors. This practice:

• reduces the risk of financial penalties and legal issues.
• ensures adherence to federal, state, and industry regulations.
• helps in identifying areas for improvement in the coding process.

Orthopedics coding repair tactic #5: Lean on technology and analytics

Advanced technology and analytics can improve coding accuracy and efficiency. That 98% of providers submit claims electronically today speaks to its efficacy. The technology you use should:

• have sophisticated analytics tools for financial performance analysis.
• identify potential coding errors or missed billable services.
• streamline the coding and billing process.

By implementing these steps, orthopedic physician groups and MSOs can enhance their coding accuracy, capture billable services more effectively, and ultimately improve their revenue cycle management.

Managing high orthopedics costs tactic #1: optimize revenue  

Orthopedic physician groups and MSOs must do all they can to optimize the revenue required to absorb the high costs associated with procedures and equipment. Our recent article on revenue cycle processes covers the 12 steps in revenue cycle management and recommends process mapping, which involves documented lists and diagrams of all the tasks in each step in the revenue cycle. Healthcare leaders agree that process mapping reflects organizational maturity, a departure from the chaos that plagues immature health systems. Orthopedics practices can recoup millions in leaked revenue by optimizing areas in the revenue cycle like underpayment, denial, and contract management. 

Take a quick, self-guided tour through a powerful revenue optimization tool: 

Automated revenue cycle management tools are paying for themselves and then some by streamlining invoicing, collections, and payment processing while reducing administrative burden. Here’s proof: 

• In a recent survey by the State of the Revenue Integrity Industry Survey, 85% of respondents experienced positive revenue impacts in the past year due to RCM technology automation.
• Black Book's survey of 1,302 healthcare professionals found that those utilizing revenue cycle automation software saw an average 27% reduction in cost-to-collect and a 6% increase in net patient revenue.
• McKinsey & Co. shares that the US healthcare sector could potentially reduce administrative costs by $200 to $360 billion through the adoption of technologies like automation, AI, and analytics.

Managing high orthopedics costs #2: track all expenses 

Tools like QuickBooks or Xero allow orthopedic practices to track income and expenses in real-time, generate financial reports, and make informed decisions quickly. Providers should then use these budgets to identify cost saving opportunities and plan for future investments. 

Physician groups and orthopedic MSOs can use contract modeling to forecast impact to revenue from their own or proposed payer changes to rates. 

 Take a quick tour of efficient contract modeling in action here: 

Managing high orthopedics costs #3: negotiate supplier contracts

Build relationships with suppliers to secure discounts on bulk orders or extended payment terms for expensive orthopedic equipment. The larger your organization, the better prices you can secure. 

Managing high orthopedics costs #4: lease rather than buy equipment

Consider leasing high-cost machinery instead of purchasing outright. Orthopedic technology evolves rapidly, so leasing allows practices to easily upgrade to newer models at the end of each lease term. This ensures access to the latest features and capabilities without being locked into outdated equipment. Predictable monthly payments also help with budgeting and cash flow management.

Improve patient collections #1: collect more upfront

Assertive upfront collections are the new reality for orthopedics groups and practices. Research shows that the probability of securing payment decreases after the patient leaves the healthcare facility. Our upfront collections article covers how you can emphasize its importance to staff and help them use compassionate, appropriate patient financial responsibility language when dealing with the public. 

Improve patient collections #2: rely on patient payment estimate technology

Patient payment estimate technology supports staff in collection efforts. According to CMS, manually researching insurance EOBs and compiling estimates manually can take a staff member up to 1.3 hours. Pre-service patient estimates delivered at point of service or even days before care helps patients understand and plan for their financial responsibility. The good news for all involved is that patients want to know their financial responsibility upfront. In fact, a study from Patient Rights Advocate, Inc. and Marist of 1,130 American adults reveals that 94% want to know what their healthcare will cost them upfront. Echoing this finding, an InstaMed study reveals that 80% of patients want this information before receiving care. 

Take a quick tour of how you can simplify upfront collections when you automate eligibility verification and estimate generation here:

Maximizing collection efforts at or before the time of service reinforces revenue. When one three-hospital healthcare organization in Florida brought in an automated patient payment estimate solution, it improved upfront collections by 45%.  

Improve patient collections #3: Institute payment plans

High-cost procedures may warrant flexible financing options so that patients can reasonably meet their obligations and even appreciate the provider’s efforts. The last thing you want is for patients to duck their responsibility, a move that impacts their credit and your revenue. Ally Deale, director of patient access operations at Maryland’s Luminis Health, explains in a Becker’s white paper,

“Too many patients don’t have a clear understanding of what their responsibility may be or what options are available to help them. So, they either don’t continue care or hide from attempts to get them aid.” 

Deale goes on to encourage practices to re-envision front end staff as patient advocates and educators apprised of how to work with financial counselors and lending partners for the patient’s benefit. With the financial piece taken care of, staff can focus on clinical outcomes rather than the financial impact of the organization’s care.

It takes a proactive approach to patient payments and education for orthopedic providers to navigate high patient balances effectively. These upfront patient collection approaches not only secure crucial revenue but also foster a more transparent and patient-friendly financial experience, ultimately benefiting both the practice and its patients.

Increase prior authorization approvals tactic #1: leverage technology

To combat the increasing complexity of prior authorizations, orthopedic practices should leverage these versions of advanced technology: 

• Implement Natural Language Processing (NLP) algorithms to review clinical documentation, ensuring accurate coding before submission. This proactive approach helps address potential issues that could lead to prior authorization denials.
  
  
• Utilize AI- and ML-driven systems to analyze and flag potential issues before prior authorization requests are submitted, streamlining the process and reducing denials. Key features of these solutions include:
• automated eligibility verification and prior authorization determination based on the patient's payer, plan, and procedure.
• AI-enabled tools that can automatically populate prior authorization forms, submit requests, and track their status.
• predictive analytics to identify potential prior authorization denials before submission, allowing providers to address issues proactively.
• real-time approvals for routine prior authorizations, significantly reducing wait times.
• machine learning features that continuously improve prior authorization processes based on historical data, helping to predict and prevent future denials.

By integrating these AI-powered solutions, orthopedic practices can streamline their prior authorization processes, reduce administrative burden, and achieve faster approvals with fewer denials.

Increase prior authorizations approvals tactic #2:  Develop payer-specific prior authorization strategies

Regularly track and review procedures that are frequently denied by specific payers. Build a database of these common rejections, along with successful appeal strategies, to refine the submission process and reduce the likelihood of repeated errors.

Increase prior authorizations approvals tactic #3: Establish proactive communication with payers

Establish open lines of communication with insurance companies to address recurring issues and stay informed about policy changes that may affect prior authorization requirements. Our article on navigating payer relationships proposes two ways to engage with payers: a positive, collaborative manner or a more assertive, direct approach. 

By implementing these strategies, orthopedic practices can improve their prior authorization processes, reduce administrative burden, and ultimately increase approval rates.

Reduce days in A/R tactic #1:  Leverage technology

Given the complexity of today’s ICD, CPT and HCPCS codes, staff must have the support of untiring, AI- and ML-powered billing software and tools. These tools automate repetitive tasks, reduce errors, and offer real-time insights into financial performance. Implementing AI-driven prior authorization software speeds up the process and reduces administrative burden, allowing staff to focus on more critical tasks.

Implementing efficient, modern scheduling systems can improve patient flow and reduce no-show rates. Verifying patient eligibility and coverage upfront minimizes denials and payment delays on the back end. Additionally, using a reliable clearinghouse for streamlined claim submission reduces errors and rejections, ensuring that claims are processed correctly and promptly. 

Finally, keep in mind that every dollar collected up front is one that stays out of A/R. Review our section above on increasing upfront collections. 

Reduce days in A/R tactic #2:  Use checklists to improve documentation

Implementing a standardized checklist ensures all necessary documentation is collected early in the care process. In all industries, checklists have proven to reduce errors and speed work.