Every Aspect of the Billing and Coding Process

Improved from Day One

Many radiology practices operate like Radiological Physicians Associates, Inc. (RPA) of Fairmont West Virginia used to operate. Like most radiology practices RPA depends on their coding, billing and collections infrastructure to support physician compensation, expansion and other efforts that the group initiates. Yet, in RPA’s case, as with many radiology practices, the coding, billing and collections infrastructure was not performing at optimal levels. Success depended on implementing a new billing solution that would incorporate best business practices to create an exceptional coding, billing and collections process.

Sam Merandi, RPA’s Administrative Vice President was tasked with developing a better billing alternative for RPA. RPA was established in 1968 and is now a 17 member radiology practice. The new billing alternative had to consider the unique characteristics of RPA and address the many issues the group faced.

RPA was not satisfied with their billing vendor and decided early on that they would either bring the billing function in house or change to a new billing vendor. Merandi and the group performed an extensive search of all available options. He knew the key was finding the right partner and a company that would bring a lot to the table, but also

be flexible enough to complement RPA’s unique business model. After an extensive market evaluation Merandi selected ADVOCATE. He and the group liked what ADVOCATE had to offer. Merandi checked ADVOCATE’s references and visited several current clients in person. The feedback was overwhelmingly positive. ADVOCATE was selected and the transition began 60 days later. Once on board, the first thing ADVOCATE did was develop a timeline for the transition and provide a projection of how much revenue RPA should generate.

RPA performs more than 360,000 procedures a year at 28 different practice locations. The transition in billing services was the major concern of the RPA physicians. They were not going to tolerate a dip in collections during the billing transition. ADVOCATE spent the two months prior to the contract effective date planning the execution of the billing transition. One week prior to the contract effective date, ADVOCATE was on site visiting each location and meeting with hospital administrative and IT staff.

The billing transition was flawless. Collections were up in the first month after the transition. ADVOCATE improved collections and enhanced reporting on every aspect of the business.

ADVOCATE integrated their proven approach to coding, billing and collections and accomplished truly superior results. ADVOCATE was able to achieve these results by applying their unique management approach and system tools on day one. These tools are designed to go right to work and closely monitor third party payer processes to ensure proper adjudication and payment of claims. These specialized systems are then continually monitored to determine if the market and payer behavior has changed.

“ADVOCATE enhanced our own understanding of our practice with their concise monthly management reporting. This real-time access to data has proven to be invaluable. We review all aspects of the practice with ADVOCATE on a monthly basis. We discuss the detailed reports and address trends and develop modifications to our management approach that improves our management effectiveness.”

ADVOCATE emphasized to the physicians that proper coding correlates directly with the quality of information provided by the radiologist in their dictated report. ADVOCATE went right to work and provided the radiologists with feedback on report format and content suggestions on specific cases as learning tools and reinforcement. Without feedback many radiologists assume all is well. The opposite is true, without feedback you do not know where the problems are or how bad the problem is. ADVOCATE’s process improved charge capture and reduced coding ambiguity. RPA radiologists had never received this type of feedback in the past. The communication between the billing staff and the radiologists has reduced denials and improved charge capture significantly. ADVOCATE emphasized during the sales process that unless a practice performs regular procedure count verification to audit the capture of billing data, practices will lose billable exams and revenue. When ADVOCATE began billing, they also began to regularly verify that 100% of all exams performed by a radiologist were billed. They electronically compared data from their billing system with data from the hospitals RIS system. ADVOCATE found that in the past, 4% to 5% of RPA procedures were not billed because the data transfer was flawed. ADVOCATE immediately addressed the issue with the hospitals to refine the data transfer.

The benefits derived from ADVOCATE’s denial management system include: accelerated cash flow, reduced write-offs and improved management information. Accelerated cash flow results from developing prevention rules that eliminate recurring initial denials caused by demographic data issues or missing information. Without this reporting your practice is flying blind. The statistics compiled from the denial management system are used to continually improve the process.

ADVOCATE also verifies that contracted payers are actually paying what they agreed to. ADVOCATE’s systems can accept a reimbursement schedule for each of our contracts and then report monthly, on a claim-by-claim basis, if the payer is living up to their end of the bargain. This is the practice’s protection against improper claim payment.

ADVOCATE understands that no two practices are alike and has developed the ability to produce custom reporting that can be generated in a matter of hours in many cases.

“ADVOCATE was the best decision RPA ever made. The transition was flawless and every aspect of the billing and coding process was improved from day one. ADVOCATE came in and did what they said they would do. Collections are up, management reporting is enhanced, administrative costs were decreased and the physicians are extremely pleased.”

If you are looking to improve profitability and need a business partner you can count on to support your practice goals, look no further ADVOCATE has the experience and proven track record to help you reach your goals. No one knows radiology better than ADVOCATE.”

 

During the first three months ADVOCATE successfully accomplished the following:

• Managed the work flow from all 28 locations
• Improved collections
• Improved hospital & patient relations
• Lowered costs and administrative headaches
• Reduced the billing lag from service date to claim file date
• Reduced the billing lag from file date to payment date
• Increased the accuracy of charge entry
• Improved claims follow-up procedures
• Reduced claim denials