Radiology’s Role in Determining Medical Necessity
Published on the July 28, 2016, DiagnosticImaging.com website
By Whitney L.J. Howell
Recently, a New Jersey court handed down a decision that could potential change the role radiologists play when it comes to determining the medical necessity of a study ordered by a referring physician.
Although the current ruling only applies to New Jersey radiologists, industry experts are talking about how it could possibly affect your responsibilities, daily work flow, and liabilities.
The Case
Allstate Insurance brought suit against radiologists who conducted MRIs and X-rays on patients who had submitted personal injury claims. The company argued the providers had not completed their due diligence in checking into whether these studies were warranted, suing to recoup $200,000 of expenditures.
Company lawyers asserted the radiologists were the imaging center’s medical directors and, therefore, bore the responsibility of verifying medical necessity. The radiologists countered that the chiropractors and other referring physicians who send them patients satisfy the state’s requirement of being “verified” providers. But, the judge ultimately ruled the onus of ensuring proper clinical evidence exists to support medical necessity and appropriateness lies with the radiologist.
According to Greg Nicola, MD, treasurer of the Radiological Society of New Jersey, the organization is filing an appeal of the ruling. The American College of Radiology (ACR) also considers the case to be unique – one that will likely only bind New Jersey radiologists, said Tom Hoffman, JD, the ACR’s associate general counsel.
“The lesson remains to realize that the radiologists aren’t in the driver’s seat about medical necessity decisions because they don’t interact daily with the patient,” Hoffman said. “They’re hard pressed to have all the sufficient clinical background on a patient.”
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/radiology-role-determining-medical-necessity
Federal Regulations and Radiology
Published on the June 11, 2015 DiagnosticImaging.com website
By Whitney L.J. Howell
Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed.
Few things can impact radiology as directly or significantly as changes to health care regulations and policies. They’re initiatives that require you to change your workflow, to adopt new strategies, and even abandon long-used systems.
From the Affordable Care Act to coding overhauls to new value-based payment systems, industry experts are watching the next set of regulatory efforts to determine the impact on your daily practice.
“In many cases, you take the approach of preparing for the worst and hoping for the best,” said Tom Dickerson, MD, chief executive officer of Illinois-based Clinical Radiologists, SC.
The coming changes will build upon an uneven playing field for radiologists and the patients who need imaging services.
Despite long-standing fears that radiology volumes were lagging, the past four years have actually seen a nationwide bump of 8%. According to Sarah Mountford, client services manager with billing services company Zotec Partners, this boost can be attributed to the expansion of Medicaid services in some states, as well as the growth of health information exchanges and a recovering economy.
In fact, thanks to the Medicaid expansion, the percentage of uninsured patients using radiology services dropped from 7.5% to 6.5% between 2012 and 2014, respectively. On the flipside, states that didn’t expand Medicaid are seeing increases in uninsured patients accessing imaging services. That’s an uptick from 9% in 2012 to 12% in 2014 – more than 4 million patients.
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/federal-regulations-and-radiology
Accounting Advice for Radiology Practices
Published on the April 23, 2015, DiagnosticImaging.com website
By Whitney L.J. Howell
Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed.
Throughout radiology, there’s no shortage of hand-wringing about slashed reimbursements and shrinking bottom lines. New requirements and regulations on the horizon could further endanger your balance sheet.
But, according to industry experts, proactive, thorough accounting strategies and choices can help keep your group or practice afloat.
“Accounting procedures are important because profit margins are declining every year due to Medicare cuts and strategies that payers are employing,” said David Yousem, MD, neuroradiology director, program development vice chairman, and radiology professor at Johns Hopkins Medical Institution. “Mind your Ps and Qs or else you won’t have a profit margin.”
Studying your expenditures and income might frequently take a back seat to your concerns over patient care and quality, but it isn’t something you can ignore, he said. Knowing how to categorize your financial activities and your business model, as well as taking a close look at your daily activities can make the difference in your practice’s monetary health and growth.
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/accounting-advice-radiology-practices?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=24042015
Who am I?
I’m a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree in international print journalism from The American University in Washington, D.C.
I launched my journalism career as a stringer for UPI on Sept. 11, 2001, on Capitol Hill. That day led to a two-year stint as a daily political reporter in Montgomery County, Md. As a staff writer for the Association of American Medical Colleges, a public relations specialist for the Duke University Medical Center and the public relations director for the UNC-Chapel Hill School of Nursing, I’ve earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.
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