One Simple Way a Radiology Group Added Value to Their Hospital Relationship

Posted: By Sandy Coffta on February 04, 2017

If you follow the leading voices in the radiology community, you know that the topic of “value” is a recurring theme of current conversations. It is a core concept behind Imaging 3.0 and has dominated recent seminars, webinars, social media chatter and more for months thanks to MACRA and the many changes it is bringing to provider compensation models. And whatever changes the next wave of governmental healthcare policy washes into the boardrooms of group practices, when the murky waters recede, it is a safe bet that proof-of-value will still remain on the table as a mandate for radiologists going forward. 

But with the above buzz focused on patient outcomes and provider payments, there is a different and not-unrelated perspective on value that is critically important for radiologists to understand – building a mutually beneficial relationship with hospital partners. Here’s one example of how a hospital-based radiology practice did so…

As we covered in a recent blog article, claims for reimbursement of radiology services are most often denied by the payer because the data contains inaccurate information about the patient’s eligibility for coverage.  This was the case for one of my new clients not long ago.  Shortly after contracting with HAP for their professional billing services, we conducted an initial analysis that showed nearly one-third of the denied claims from the practice were due to patient eligibility issues.  Researching further, we found that the problem was directly caused by how the hospital was capturing primary vs. secondary payer information, with Medicare and Medicaid patients representing the most common issues.  

Working with the radiology group president, we prepared a report on the findings and presented it to the hospital’s director of patient registration. As the conversation progressed, it became clear that the hospital could not access and analyze the denial data as fast as we could and thus were not aware of the problem.  Read the complete article here:

Sandy Coffta is Vice President of Client Services at Healthcare Administrative Partners where she specializes in reporting innovation and business intelligence solutions for the company’s radiology practice clients.

Related articles:
How to Avoid Radiology Claims Denials – Eligibility Problems
The Top 3 Reasons for Radiology Claims Denials and How to Avoid Them