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Technologists play a major role in the revenue cycle

Radiology Administrator's Compliance and Reimbursement Insider, September 1, 2008

Editor’s note: This excerpt from the Radiology Technologist’s Coding Compliance Handbook will help you understand the technologist’s role in the revenue cycle and in billing, coding, and documentation.

Radiology technologists play a pivotal role in the revenue cycle. This cycle begins as soon as patients are scheduled, and it can easily break down if technologists fail to:

• Review test orders
• Understand coding, billing, and Medicare regulations
• Query patients about clinical information

In the initial phases of a patient’s encounter, technologists must collect accurate information and question any discrepancies.

Diligence at this stage—on the front lines of patient care—aids the facility in getting properly reimbursed for studies and complying with regulations such as Medicare.

One mistake—even an unintentional one—could cost the facility thousands of dollars.

Documentation and coding

Technologists are often the only people with clinical knowledge with whom a patient comes into contact during outpatient diagnostic testing. For this reason, technologists play a key role in ensuring documentation and coding compliance.

Because technologists possess clinical knowledge and insight that clerical personnel do not, it is their responsibility to document patient information with appropriate medical terminology and to question whether a specific diagnostic test is clinically appropriate or medically necessary based on a patient’s history.

This clinical knowledge and understanding of testing protocols allows technologists to raise questions regarding these matters and to communicate effectively with physicians as necessary.

Obtain the patient’s history

Obtaining and documenting the patient’s history is important for diagnostic tests performed on an outpatient basis—particularly when ordering physicians have not provided a reason for the test and additional information is unavailable.

Therefore, prior to performing a diagnostic exam, technologists must take the following steps:

1. Query the patient to decipher any symptomology he or she is currently experiencing. In other words, find out why the patient is having the test and ask about any past or chronic health conditions that might affect how you perform it.

Tip: This information might be the deciding factor at the time of coding and billing as to whether the exam is considered medically necessary.

2. Ask whether the patient has had any adverse reactions to contrast materials during past exams.

Handle diagnostic test orders

The treating/referring physician must order all diagnostic tests.

According to CMS, any of the following may constitute an order:

A written document signed by the treating/referring physician and hand delivered, mailed, or faxed to the testing facility

A telephone call from the treating/referring physician or his or her office to the testing facility when both parties document the phone call and the required information in their respective patient records

An e-mail from the treating/referring physician or his or her office to the testing facility

When referring physicians do not provide diagnostic information that documents the reason for the test, ask the patient why his or her physician ordered the test or check the patient’s medical record. If you take information directly from the patient, you must make a concerted effort to verify it by contacting the referring physician.

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