Home

  • Home
    • » e-Newsletters

Hire designated coder, increase radiology reimbursement

Radiology Administrator's Compliance and Reimbursement Insider, July 1, 2006

Money doesn’t grow on trees. If it did, radiology managers and chief financial officers (CFO) would certainly pluck their fill from the outstretched branches. But imagine picking $400,000–$500,000 of extra revenue for your facility.

That’s the amount that Jamie Heldt, director of imaging and cardiology at Oakwood Healthcare System’s Heritage Hospital in Dearborn, MI, says her department gathered by hiring its own radiology coder. Although there remains much debate over bringing a coder on board, Heldt believes that her coder’s green thumb helped the radiology department’s finances grow.

Step #1: Plant the seeds

Robin Russ, director of imaging and cardiology at Oakwood’s Annapolis Hospital, works in a 200–280-patient facility. At 180 patients, “we’re screaming busy,” she jokes.

But with more than $50 million in annual business transactions, imaging reimbursement is no laughing matter, she says. Especially since an independent auditor found her radiology department captured only 20% of billable revenue.

It’s not a problem unique to Russ’ department, either. Many radiology facilities simply leave the money on the tree for a variety of reasons. Some do not track claims denials, others do not validate medical necessity, and still others code incorrectly. For all of these reasons and more, says Russ, a designated radiology coder represents the vital financial farmer that facilities need. “We had to figure out something to resolve this issue,” she says.

Step #2: Germinate ideas

Russ joined the Oakwood system’s leadership training group. The group included roughly 25 people from all walks of hospital life. Together, the team debated the pros and cons of hiring a specific coder, planted the concept in the minds of their superiors, and communicated the suggestion up the leadership chain to the CFO. The CFO then approved the radiology coder position.

A year and a half after the designated coder started, Russ says, her organization had saved hundreds of thousands of dollars. “It’s worked out great,” she says.

When Heldt saw her counterpart’s success, she moved to enact a similar program in her own radiology department.

Use data to support coder claims

Provide comprehensive financial data to prepare others for change, says Jim Sutton, radiology director at May Health Systems Fairmont Medical Center in Fairmont, MN.

“Understanding the overall fiscal benefits impresses the higher administrators,” says Sutton. “If you show them how hiring a designated coder increases revenue, then you will convince them.”

Take the following steps when making the case for a designated radiology coder, he suggests:

  • Perform a retrospective audit. Learn how much money isn’t being collected and why.
  • Compare fiscal data of your facility to data of other demographically similar facilities.
  • Include the financial burden of salary and other benefits assumed in hiring a radiology coder.
  • Perform additional audits to determine how much lost revenue your facility could save by implementing this new strategy. The more data presented to decision-makers, the better.

    “You can extrapolate out what your facility might save,” he says. In the case of some facilities, Sutton saw up to $11 million collected.

    At Oakwood’s Heritage Hospital facility, different charges stemmed from different mistakes, says Heldt. She and her team plotted the mistakes and showed how much the hospital could save by hiring a radiology-specific coder.

    Looking back at the data, “we could see actually when our coder started,” Heldt says. “Now, we have zero errors.”

    Step #3: Nourish the idea

    Whereas some centers perform self-examinations through front desk staff and computer programs, others use a designated coder, Sutton says. Asking “why” and “how” to collect reimbursements is as important as “how much” money you will collect, he says.

    When auditing the radiology department, shake the reimbursement tree for additional information as well, he says. Missing data—not entry mistakes—accounted for 73%–78% of claims denials, says Sutton. “We really needed to have someone looking at [these] data on a consistent basis,” he says.

    Step #4: Harvest the growth

    In Heldt’s Heritage Hospital radiology department, a technologist disenfranchised with advancing imaging technologies sought to retire from her post. “We saw this as an opportunity,” says Heldt. “We wanted to simultaneously provide a new career opportunity for someone we didn’t want to lose and boost our reimbursement rates.” The former technologist became the department’s new coder.

    The coder examines numerous variables in reimbursement. And, says Heldt, because the coder knows the radiology business, she speaks the clinical language needed to communicate between departmental silos—from radiologists to technologists to referring physicians.

    “She talks to a lot of different departments and to the different offices. She tells them what we need and why we need it,” says Heldt.

    Sutton encourages facilities to migrate radiology technologists into designated radiology coding positions. “The technologists know the medical side of the procedures,” he says. “It’s far easier for a technologist to look at an interventional radiology report and know that a certain step of the procedure isn’t documented.”

    To start collecting the fruits of the radiology department’s labor, put all of these harvesting tools together. “The money we saved far outpaid the cost of the position,” Heldt says. “We recovered $400,000–$500,000, and that’s well worth it, in my opinion.”

    Insider sources:

    Jamie Heldt, director of imaging and cardiology at Oakwood Healthcare System’s Heritage Hospital, 10000 Telegraph Road, Taylor, MI 48180; heldtj@oakwood.org.

    Robin Russ, director of imaging and cardiology at Oakwood Healthcare System’s Annapolis Hospital, 33155 Annapolis Street, Wayne, MI 48184; russr@oakwood.org.

    James Sutton, director of radiology at Mayo Health System’s Fairmont Medical Center, 800 Medical Center Drive, Fairmont, MN 56031; sutton.james@mayo.edu.

    • Most Popular