Radiology Administrator's Compliance & Reimbursement Insider, August 2005

If you can't answer these questions, ask yourself another one: "Why shouldn't my employer outsource my position?"

Remember that happy employees will help your organization perform better. "At the end of the day, the thing that separates your practice from others is your people," Freiberg said. n

Insider source:

Kevin Freiberg, EdD, president and chief executive officer, Freibergs.com, San Diego.

Hire for attitude, train for skill

The following questions were developed by Drs. Kevin and Jackie Freiberg to help interviewers ferret out positive employees who will add to an organization and weed out negative candidates who have the potential to sour the work environment. The words inside the brackets indicate what type of information the question seeks to elicit from the candidate.

Questions you can ask to screen for attitude

Another exercise you can use to screen for unselfishness and teamwork begins with asking interviewees to prepare five-minute presentations about themselves for a group interview.

As each presenter comes up to share his or her personal story, watch the audience members to determine whether they enthusiastically draw the speaker out and encourage him or her [unselfishness] or whether they make last-minute notes for and prepare their own presentations [selfishness].

Notice that these questions are not hypothetical (i.e., what would you do?) questions. These questions ask for previously demonstrated behavior as a means to determine future success.

Your questions will become more powerful and targeted if you first identify your star players in a particular function and then build a profile of the key attributes that are common to each of them. Successful screening begins with knowing precisely what it is you're looking for.

Editor's note: The Freibergs are professional speakers and authors of the recently released GUTS! Companies That Blow the Doors Off Business-as-Usual and bestseller NUTS! Southwest Airlines' Crazy Recipe for Business and Personal Success. To read more about Drs. Kevin and Jackie Freiberg please visit their Web site at www.freibergs.com .

Coding advice related to patients who have a history of breast cancer

Q: I have been told by the local Medicare official that if a woman has breast cancer on one side and undergoes a mastectomy, any further mammograms on that side should be diagnostic.

The same is true if a woman undergoes a lumpectomy. In a nutshell, I was told that Medicare states that all future mammograms on women who have had cancer diagnoses are diagnostic, not screening.

However, in the past I have read your advice on how to bill for screening mammograms on women who have undergone unilateral mastectomies.

You advised that a unilateral screening mammogram should be assigned code 76092-52 and stated, "coverage generally is not a problem."

The challenge is in getting the referring physicians to order the unilateral screening study.

Is it possible to bill for a screening mammogram on a woman who has had a cancer diagnosis as described above?

A: This issue boils down to the referring physician order; the type of exam the physician orders is what should be performed and billed for.

We generally find that most physicians believe a patient who is post-mastectomy for breast cancer should always have a diagnostic mammogram rather than a screening mammogram.

Some Medicare carriers, such as the one listed below, recognize this as a valid reason for a unilateral diagnostic mammogram.

Florida-based First Coast states in its local coverage determination (LCD): "Unilateral diagnostic mammograms may be performed when a patient has had a unilateral total mastectomy."

In order to perform a diagnostic mammogram, there must be an order for the exam from the patient's treating physician (or the exam must be ordered by the radiologist due to an abnormal screening mammogram on the same date).

However, not all Medicare contractors agree that a history of breast cancer always supports a diagnostic mammogram.

For example, the following comes from the LCD issued by New York- based insurer HealthNow:

"Diagnostic breast evaluation may be indicated in cases of a personal history of malignancy and in cases of benign biopsy-proven disease.

Once clinical stability has been established, the routine use of diagnostic mammography over screening mammography is not warranted."

If it is determined based on the referring physician's order and local Medicare policy that a unilateral screening mammogram should be performed, this service should be coded as 76092-52.

By Current Procedural Terminology definition, 76092 is the only code that is appropriate for a screening mammogram, and because it is inherently bilateral, use of modifier -52 (reduced service) is appropriate.

Insider source:

Melody Mulaik, MSHS, CPC; CPC-H, RCC, Coding Strategies Inc., Powder Springs, GA.

Keep your business on track, improve accountability

The key to successful management is accountability. Without accountability, it is difficult to keep your company's mission on track, employees moving forward, and the business performing at its best, said Marc Halley, MBA.

Halley spoke during the Radiology Business Manager's Association meeting in Las Vegas in June.

Everyone within an organization must be accountable--from the top down. To accomplish this, the sponsors or the heads of an organization must

In addition to setting expectations, they must also overcome barriers. To many people, accountability carries a negative connotation. However, Halley doesn't see it that way. "We cannot use accountability as a method to get rid of someone," said Halley.

An organization must have "pure motives"--which is the goal of improving the business--to establish a true culture of accountability, he said.

Beyond accountable administration and management, it is critical that you have a strong team of employees who work to bring about change. "If we harbor 'C,' or average players it's tough to create a culture of accountability," said Halley.

Identifying weak employees

Halley offered a simple tool that is designed to help managers determine how employees are affecting their organizations. Managers should think about each person on staff and determine whether he or she is

Put each of your employees in one of these categories. Then determine whether you can train them to rise to the needed standards or whether you might need to seek out new members for your team. Your organization should look to hire and retain only "A" players and reassign or fire those who are not meeting that standard.

Setting expectations

As important as it is to track employee performance, you must first set clear expectations and goals.

It's impossible to hold people accountable if you don't have a solid grasp of what staff are expected to do and when they are supposed to do it. It is critical to establish

Employee progress should be tracked regularly. "Everybody needs to be held accountable weekly by somebody," said Halley.

Successful delegation

Delegation can be used as a means of establishing accountability, said Halley. Managers should assign tasks to employees and track performance. But keep in mind that delegation is not

Effective delegation provides training and development opportunities for your employees.

It should also help allocate resources to help achieve your organization's goals, said Halley.

Effective delegation begins as part of short-term planning.

The manager must decide what tasks can be delegated and set goals regarding the desired outcome and the time frame required to achieve that outcome. It should also be decided who the delegate will be.

After making these decisions, the manager should

Barriers to accountability

Holding employees accountable isn't as easy in practice as it is in theory. There are several barriers, said Halley.

Attitude is often one of the major barriers to achieving a culture of accountability. Many employees will have the attitude that "this isn't high school, [I'm an adult]," said Halley. Others barriers include the following:

You must be willing to confront these issues to establish a culture of accountability.

Halley listed the following benchmarks that indicate whether an organization has truly attained a culture of accountability:

Insider source:

Marc Halley, MBA, president and chief executive officer of Ambulatory Management Services, Inc., Westerville, OH.

Editor's note

In the July issue of RACRI, the p. 7 story "Designated Coders can Perk up your Bottom Line" indicated that "there is not much specific training available for radiology coders." We received several responses from readers who pointed out that there are in fact a number of training resources available, including a certification program for radiology coders.

In addition to the radiology coding seminars and educational coding products offered by the Radiology Business Management Association, there are also a number of other resources offered by the American College of Radiology, the Society for Interventional Radiology, and other resources.

IOM: Audit required for mammography facilities

A new report by the The Institute of Medicine (IOM) recommends that the FDA require mammography facilities to track their performance using new standardized measures to determine how accurate they are when it comes to breast cancer detection.

The report also suggests that reimbursement be increased to cover the costs associated with the increased workload, according to a written release issued by the IOM.

"The audit currently required under the Mammography Quality Standards Act [MQSA] is not as useful as it could be for improving the reliability and accuracy of these readings," said committee chair John Ball, executive vice president, American Society for Clinical Pathology in Chicago, in a written release. "The effectiveness of mammography greatly depends on how well staff interpret breast images. We've proposed both mandatory and voluntary ways to enhance the measurements used to assess performance."

Currently, the MQSA does not require facilities to use specific statistics to determine how accurate the facility is when conducting and reading mammograms. To standardize the process the IOM report suggests the following:

The new audit requirement was recommended in a report sponsored by the FDA in preparation for the anticipated reauthorization of MQSA in 2007.

In addition to the auditing proposal, the IOM also recommended that MQSA be expanded to include other breast imaging procedures. It recommended mandatory accreditation for breast ultrasound and magnetic resonance imaging as a means of ensuring quality for what are now routinely used procedures, said the written release.

• E-mail to a Colleague
• Print