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By AHRA Staff

January 2001–New Members

The staff and members of AHRA warmly welcome the following new members!

Goran Abramovic, Cheektowaga, NY
Marcia Amaral, Shrewsbury, MA
Karen Browne, Marthasville, MO
Vicki Burnett, Chapel Hill, NC
Terri Ann Dewey, Marine City, MI
Pamelia Fox, Lewisville, TX
Cherylann Green, Melbourne, FL
James Kellar, Huntington, WV
Cheryl McGlothlin, Pineville, LA
Nita Ness, Menomonie, WI
Jane Nolan, Andover, MA
Michael Rector, Bellevue, WA

Do you know someone who can benefit from an AHRA membership? Let us know! Send the contact information to our membership department at memberservices@ahraonline.org. If your referral joins, you’ll be listed here as well!


January AHRA Webinar: Starting the Year Right …. Coding and Reimbursement for 2011

Thursday, January 20, 2011
1:00 PM – 2:30 PM EDT
Featuring: Melody W. Mulaik, MSHS, RCC, PCS, FCS, CPC, CPC-H
President, Coding Strategies, Inc., Powder Springs, GA

This webinar is generously sponsored by Coding Strategies, Inc.

Each year brings new coding and reimbursement changes and key areas of focus for compliance concerns and 2011 is no exception. Incorporating these changes in your organization is critical to ensure that appropriate reimbursement is not lost unnecessarily. In this session, the new, revised and deleted procedure codes for 2011 will be reviewed so that attendees can ensure necessary charge capture changes and educational needs. Special focus will be placed on the new lower extremity revascularization procedure codes. Key reimbursement changes will be reviewed at an APC level so that the financial impact can be determined for each organization.

To register for this and other upcoming webinars, click here.


Online Institute Feature

Financial Management in Radiology
Chapter 1: Understanding Financial Statements

Financial reports provide the basic accounting tools a radiology facility needs to asses its fiscal health as an organization. This chapter sets forth the fundamental concepts, conventions, rules, and procedures involved in generating and understanding financial statements. The three components of financial reporting –balance sheets, statements of operations, and statements of cash flows—demonstrate how an organization examines assets and liabilities, operating revenues and expenses, income, and other financing activities. The chapter also explains how to derive and evaluate key financial ratios to determine an organization’s well-being in terms of profi tability, liquidity, and asset management. Comparable ratios for the hospital industry are included. The chapter concludes with a discussion of comparative, trend, and percent change analyses.

Click here to view this and other archived webinars, Quick Credit articles, Professional Development Series textbook chapters, and conference sessions, as well as to take the associated CE exams.


From the Forum

Building upon the popularity of the AHRA List Server, the new AHRA Forum is the next incarnation of a members only discussion group. It has new features, increased functionality, and incorporates a searchable archive of 90,000+ messages brought over from the List Server. Easily accessible, this networking tool enables real time dialogue among imaging professionals through AHRA’s website or via email.

Below is a recent discussion:

“1st Scenario: Referring physician orders a CT Abd for aortic dissection. Per department protocol, we do a CT chest/abd/pel with contrast to evaluate the complete aorta. Patient gets prompt and accurate diagnosis and proceeds with their course of care.

“2nd Scenario: Referring doc orders, via CPOE (physician order entry), an ap/lat lumbar spine. In comments they describe that they actually want a lumbar spine with flexion/extension. Doc refuses to change order stating, ‘I don’t give a hoot about CPT codes. You know what I mean, just do it.’

“3rd Scenario: Referring doc, with no communication to the rads nor technologists, writes a description of an exam ‘CT aorta with and without contrast to evaluate dissection.’ Per department protocol, we do a CT chest/abd/pel with contrast to evaluate to complete aorta. Referring physician has conniption because we ‘didn’t do what was
ordered.’

“I’m certain you all have similar issues. Our referring docs run the gamete from, ‘Just call me and I’ll send you whatever you need to get the patient done,’ all the way to, ‘Don’t ever call and question my clinical authority, just do what I order’ (despite the complete incorrect exam being ordered to evaluate the listed diagnosis).

“Around here, we follow department protocol. Questions are asked of the referring physician if the order is not clear (this is met with varying degrees of cooperation). Outliers are run by the radiologist for input and guidance. Most physicians will speak with the radiologists if there is “something special” they are looking for. Still, there are some referrers who do not communicate so well with us.

“In your radiology world, who decides? Do you ‘just do what’s ordered,’ right or wrong? Is there a decision tree of some sort?”

–Matt Jones, CRA

Responses:

— Most of our docs are okay with the protocols approved by med exec. Some specialists (new to the system) sometimes want things different or have a “just do it” attitude, but we try to get a radiologist involved and eventually they become more adherent to the department’s protocol. We don’t have CPOE yet.  However, I am sure we will have some of the same issues you mention when we do go towards that.

— 1st Scenario: when changing an order, the insurer needs to see the
order matches the exam. Radiologists do not have the authority to
‘change’ orders to match department protocol, rather to add contrast in order to ensure patient care. I would make a call on each and every
patient. Once department workflow is inhibited and calls are coming and going, you may have a different reaction from ordering docs.

2nd Scenario: I would have my staff change the order to a
flexion/extension and keep a copy of the original order with everything and send to medical records. It’s our responsibility to complete the correct exam.

3rd Scenario: You are covered because the aorta covers all three parts of this exam. However, in an audit I believe your people would have a difficult time defending this and I would force a more complete order. ALARA also comes into play here.

The more calls a doc gets (no matter how upset they are) the more likely they are to adhere to doing it right the first time.

— We went live with CPOE about 2 months ago. Referring providers are aware of the radiologist protocols and accept them. The ED doctors are in the “do as I say boat,” however they are a bit accepting of the protocols and the radiologist allows the tech to do as the ED doctors want.

Scenarios 2 & 3: We do not do the exam until it is ordered correctly. We call the provider and have it inputted again. Administration has been hammering providers about proper ordering for proper reimbursement. Like ten in-house MRIs two months ago down to two in November.

The providers are employees of the medical group and the medical group is a division of the medical center. So administration hits them in their pocket when there are issues with incorrect ordering in the form of poor evals.

— The more times you call the office, the more the provider will do it correctly. In addition, the patient is aware of the reason for waiting for the exam and the patient is well aware of the fact that if the exam is denied and they signed an ABN, we bill them.

To read more of this conversation and for more information about the AHRA Forum, click here.

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