New Healthcare and How It Will Impact healing Billing

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Radiology practices and imaging centers face many threats to their profitability. Radiology billing is becoming even more complex, and reimbursements are steadily decreasing. There are three key challenges you'll need to understand and address for your radiology firm to thrive in the advent years.

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How is New Healthcare and How It Will Impact healing Billing

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The future is less.

Bundling of services and codes has already resulted in lower (and in many cases significantly lower) reimbursements for providers. Some revised codes carry lower Rvus, reflecting the confidence that those services were previously "misvalued" (overpriced).

The Medicare cost Advisory Committee (MedPac) recently recommended measures to further reduce imaging reimbursements, together with lowering the threshold for bundling report from 75% to as low as 50%, reducing expert component payments for complicated procedures and studies conducted by the same practitioner during the same session, and discounting payments for providers who both order and read images.

Some "thought leaders" (see the Radiology firm Journal June/July 2011) think that expert component reimbursements are likely to decrease other 30% over the next five years.

Complexity is increasing.

Impending new coding procedures will sway both clinical and firm operations. New compliance requirements will further sway radiology billing procedures. And then there's the move toward more electronic data standards and requirements.

With Icd-10, coding isn't naturally being refined and updated. New codes will be longer, and there will be a lot more of them. Rvus will be different, too. Since you won't see much matching in the middle of Icd-9 and Icd-10, your staff will have to form out how to accurately "translate" to the new world.

Of course, we can count on the government to keep working to "correct" pricing, find new bundling opportunities and eliminate overuse of procedures. You'll also see more emphasis on linking radiology billing and reimbursements with outcomes measurements, addition on initiatives such as Pqrs (was Pqri).

Change is the new normal.

Your in-house costs are going up.

Daily operations costs will keep increasing, and incorporating new radiology billing requirements will add cost pressures to your financial situation.

Coding and billing staff will have to learn an exhaustive new Icd-10 coding law very quickly. Even after the October 2013 change-over deadline, providers will have to continue processing Icd-9 codes for services rendered before the deadline. Since payors will have an extended deadline, you may face further "dual" processing issues. This will originate more work for your staff and perhaps unwanted repayment consequences, too.

New, more involved ways to link financial data to repayment will wish more sophisticated technology and better trained staff. Failure to accurately document outpatient data, together with benefits details, could corollary in increased denials, even fines.

Annual planning and budgeting may be tougher, because the Icd-10 timeframe doesn't announce changes until October, giving you less than three months to get ready for the next fiscal year.

These radiology billing challenges mean even more concentration to the ever-changing coding and compliance requirements. And you'll have to manage the firm side of your institution or center smartly and efficiently to remain contentious and prosper.

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