By Stephen P. Ellerman
April 2011–With the rising costs of diagnostic imaging, some health plans and Medicare have aggressively lowered radiology rates and now utilize radiology benefit managers (RBMs) to authorize scans. As a result, practices have felt a squeeze in traditional sources of revenue, forcing radiology providers to diversify their portfolios. Today, Workers’ Compensation has the potential to open up a steady and reliable stream of new referral and revenue sources. Following are seven key things to know about building your Workers’ Compensation line of business.
1. Significant business opportunity.
Workers’ Compensation is an $80 billion industry, which spends approximately $3 billion a year on diagnostic radiology. A significant portion of referrals (about 70%) are for advanced imaging, eg, MRI and CT scans. These imaging services are critical to Workers’ Compensation, as they provide fast, comprehensive information on which to determine the nature and severity of an injury, as well as an accurate diagnosis and treatment plan for an injured worker. As such, this segment presents significant opportunity to increase your volume of business.
2. Ease of doing business.
In addition to reduced rates, traditional healthcare presents a slate of other challenges, such as complex billing, delayed payments, and hassles in obtaining authorizations from RBMs. Workers’ Compensation, on the other hand, is a relatively easy market segment in which to work. The industry utilizes a fee-for-service payment model, so there are no complex capitations, deductibles, or copayments to track and collect. In addition, rather than deal with traditional means of claims submission—via snail mail or fax—Workers’ Compensation leverages electronic billing with automated acknowledgement of receipt, which serves to simplify billing and speed up the turnaround on payments.
3. Specific industry dynamics and players.
Insurance companies and third party claims administrators—commonly referred to as payers in Workers’ Compensation—have found it advantageous to outsource the scheduling of diagnostic radiology exams to specialized Workers’ Compensation radiology networks. Claims adjusters and nurse case managers typically do not have a way to locate and identify appropriate facilities. A radiology network, on the other hand, has a nationwide database of credentialed providers, and can easily look up their location, type of equipment, secondary languages, hours or operation, and more. This data makes it easier to find an appropriate imaging facility. To build your Workers’ Compensation business, all you need is to find the right network partner.
4. Workers’ Compensation radiology network has much to offer payer clients.
A sophisticated network will have a scheduling center, ensuring a high level of service and patient advocacy for injured workers. It will have care coordinators who can typically schedule a test within 24 hours of receiving a request, and help to identify a provider who is located in close proximity to the employee’s home or work site. Payers choose to work with networks that utilize a stringent provider credentialing process, which ensures injured workers are sent to only the most qualified imaging facilities and radiologists. Be sure to align with a network that offers these quality services to its clients.
5. Value in partnering with the “right” network.
There are several benefits to partnering with a well established Workers’ Compensation radiology network. First, they will provide your practice with immediate access to many key payers, so imaging facilities can quickly increase their volume of referrals and revenue, without associated marketing costs. With a health plan, your practice may simply be listed in a provider directory, but a Workers’ Compensation radiology network actually steers referrals to its providers.
Second, partnering with the right network will help you foster new referral sources, such as a physician office you may not have worked with before. Once a physician sends patients to your imaging facility, if you continue to deliver quality scans and service, the physician will likely send other patients to your practice. In the end, a network partner should enable you to increase your referrals and revenue.
6. What to look for in a network partner.
Key criteria to look for when evaluating a potential partner include:
a. Favorable contract terms and conditions. The network should offer rates that are fair and competitive in the Workers’ Compensation market.
b. Prompt turnaround on payments. Payments should be made independent of a network’s reimbursement from its payer clients. Be sure to request the network’s payment history to verify timeliness of payments.
c. Significant volume of exams. Request the network’s list of payers to assess its penetration in the Workers’ Compensation market, particularly in your region.
d. Good reputation in the radiology community. Request a list of references to verify the network has a solid reputation among other radiology practices, and to ensure it consistently adheres to its contract terms.
7. Ensure your success in the Workers’ Compensation market.
To succeed in this line of business, your facility must have quality technologists, radiologists, and state of the art equipment. In addition, a key focus is to ensure injured employees return to work quickly. When a network calls with a referral, try to schedule the patient the same day, if possible. Typically, the injured employee is out from work, and the treating physician is waiting for the medical report to outline the patient’s treatment plan. Providing prompt, friendly service goes a long way toward a successful Workers’ Compensation business.
Stephen P. Ellerman is vice president of provider development at One Call Medical (www.onecallmedical.com), a leader in diagnostic management solutions. He has been a speaker on improving your Workers’ Compensation line of business at AHRA and RBMA conferences. Ellerman has over 20 years of diagnostic radiology provider relations and development experience. He can be reached at One Call Medical, 20 Waterview Blvd., Parsippany, NJ 07054, via email at firstname.lastname@example.org, or telephone at (973) 316-3755.