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MIPS considerations for Radiology practice

Merit-based Incentive Payment System (MIPS) is part of Quality Payment program, which implements provisions of the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA).

 

For radiologists, participating in the first performance year evolves three options – test, partial, and full.

 

MIPS will begin to take effect for Medicare physician reimbursement in 2019 but those payment adjustments will be determined by performance reported for 2017, which is being termed a ‘transitional year’ for the program. The reporting period for 2017 has been lowered to a minimum of 90 days rather than a full year for all of the MIPS categories.  It is expected that MIPS will be in full effect for 2018. The Medicare payment adjustment in 2019 will be based on submitting data and the radiologist’s performance for the following MIPS categories in 2017:

 

  • Quality performance (60%)
  • Cost (0% for first year)
  • Advancing Care information (25%)
  • Improvement activities (15%)

Merit-based Incentive Payment System (MIPS)

Quality:

The key idea here is the assessment of value of care given to patients. The following areas need to focused on: clinical care, patient safety, care coordination, patient and caregiver experience, prevention and population health, and affordable care. The idea behind this is to promote and ensure high clinical proficiency, professional diligence and thoroughness.

 

Radiologists have focused for decades to create ways to lower radiation dose and using techniques, such as “Image Wisely” and using calculation methods go administer lowest possible diagnostic quality dose for adult CT scans iis critical. Similarly, they must report radiation dose/time for fluoroscopic procedures.Radiologist should report to Radiation Dose Index Registry all necessary events.

 

Accurate and unambiguous reporting is emphasize minimizing hedging terms and vague descriptions is encouraged in order to make reports clear, succinct and actionable. The reports should include patient reminders for follow up imaging-related visits. The reports also need to include all key information, such as stenosis measurement in carotid imaging reports. Radiologist should also follow up with referring doctors about biopsy results and imaging findings.

 

Improvement Activities Performance:

The focus here is on Support care coordination, patient engagement, patient safety, population management, and health equity. Important points include:

  • Radiology practices with fewer than 15 ECs and those who are considered non-patient facing only need to report 1 high-weighted or 2 medium-weighted IAs to receive the full credit of 40 points.
  • Only about a dozen or so improvement activities are currently applicable to radiology, and few are high-weighted.
  • Most applicable IAs will be found in the Beneficiary Engagement, Care Coordination and Patient Safety and Practice Assessment categories.
  • Group reporting provides an advantage since a single individual’s participation gives credit to the entire group.

 

Advancing Care Information:

Support the secure exchange of health information and the use of certified electronic health record technology (CEHRT)

 

There is an  Advancing Care Information performance category score, which includes:

  • base score,
  • performance score
  • bonus score.

 

There are two measure set options for reporting:

  • Advancing Care Information Objectives and Measures
  • 2017 Advancing Care Information Transition Objectives and Measures

MIPS eligible clinicians need to fulfill the requirements of all the base score measures in order to receive an Advancing Care Information performance category score. If these requirements are not met, they will get a 0 in the overall Advancing Care Information performance category score.

 

A Radiology department/practice should first, estimate its current MIPS score. Then, it should help educate the organization, particularly upper-level executives advising them on what needs to be reported on, where they should focus effort, and why. And then, they should look at maximizing their quality score.

Imaging suite workflow optimization with AI

An imaging suite/department has many moving parts. There are several steps involved:

  • patient scheduling
  • protocol selection and patient preparation
  • tracer/agent administration
  • image acquisition & processing
  • RIS/PACS
  • image interpretation & reporting
  • radiologist performance analytics

 

Let’s review these to see how AI can play a role therein.

 

Patient scheduling:

There are many software solutions on the market today that have attempted to streamline and automate the process. The main goal is to reduce downtime and optimally utilize resources, and in addition, ensure an efficient and reliable way for patients to make their preferred selections. AI can play a role in helping the patient find the most desirable time slot while ensuring that the resources such as camera time and personnel are optimally utilized. Furthermore, it can send automated follow-ups and help in rescheduling for new time slots as needed.

There are many software solutions in the market today that have attempted of streamline and automate the process

Protocol selection and patient preparation:

There is a wide variety of protocols used in adult and pediatric imaging. Choosing between them can be hard and several factors come into play. There are instances where wrong protocol selection leads to suboptimal images, overdoses, patient discomfort or even morbidities. AI can (semi-)automate the process by which the system can use the available information, such as patient age, sex, body habitus, serum levels, allergic/medication history, prior imaging, prostheses, other contraindications etc. and provide the most suitable protocol. This can ensure patient safety and desirable imaging results leading to superior quality of medical care.

 

Image acquisition & processing

AI is playing a big role here. There is a lot of research showing improved image acquisition using AI, whether it is MRI or PET. Improved acquisition techniques have led to faster imaging time, lower radiation dose, higher resolution, etc. Post-acquisition processing has benefited from AI as well, including 3D-iterative techniques and kinetic modeling, etc. AI continues to grow by leaps and bounds in this space.

 

RIS/PACS

AI has the potential to impact radiology information system (RIS) and picture archiving and communication system (PACS). AI-based hierarchical worklists, nuanced feedbacks, trend analytics, lesion tracking, synoptic processes are in the pipeline and once implemented can greatly improve the clinical radiology workflow.

 

Image interpretation & reporting

The role of AI is quite prominent here as well. From CAD to radionics, AI is innovating automated lesion analysis to unravel subvisual information on disease processes. Likewise. AI-driven semi-automated structured reporting that checks for errors in real-time and provides instant feedback are poised to streamline the reporting process and make it safer, accurate and informative. AI can also aid in the radiologist-referrer communication loop in order to ensure effective transfer of critical knowledge to the ordering doctor for immediate action as needed. This reduces the chances of miscommunication that may lead to clinical mismanagement.

 

Radiologist performance analytics:

Finally, AI is able to significantly improve the existing radiology performance system by introducing novel but useful metrics, such as hedging scores, feedback scores, biopsy results, protocoling errors, etc., and help create a more holistic performance evaluation of the radiologist, which can accurately identify deficient areas in clinical practice.

Clinical Context & Synopsis Generation from EHR

Clinical workload is increasing. Clinicians are seeing more patients and radiologists are having to read more scans in a day. Also, as the electronic health record system gets more sophisticated and detailed, we have access to unprecedented amounts of data. This is a scenario where doctors have more patients to see, more data to consume and better results to aim for. It’s a challenge and an opportunity.

 

EHR’s are getting smarter. They are no longer the dumping grounds for every bit of digitized patient data. It is a mineable repository of extremely valuable information shrouded in redundant noise. In the early days of EHR, it was difficult to sift through hordes of lab values and clinical/rad/path reports and have a nice summary of what’s been going on with the patient. A physician would have had to spend an inordinate amount of time to do so before every encounter. When HL7 FHIR came about, mining data from EHR became possible. It opened the floodgates for developers and informaticists to work with physicians to make EHR more user-friendly, providing itemized, relevant information as needed in a clinical workflow.

The system has to be reliable in the sense that it doesn't miss out key information from a parent source

The main concept of clinical context generation is that the care provider should have ready access to all the relevant information pertaining to the patient he/she is-bout to conduct the care of. The technology that made it possible is Natural Language Processing (NLP), which is a methodology concerned with automated interpretation and generation of human language. It depends on ontology libraries to help mine data through FHIR to create synoptic reports for real-time consumption by the physician. An example of that would be that if patient XYZ is having an MRI scan of his knee for meniscus tear surgery, a synoptic report would be created using keyword searches and text mining into the clinic notes, prior radiology reports, lab reports, prior procedure notes, etc.. The report would use NLP to create human language format and embed all the information that is ranked based on hierarchy of relevance. The radiologist would then be able to access just that report, as opposed to all the patient chart.

 

The system has to be reliable in the sense that it doesn’t miss out key information from a parent source, weights it correctly so that it makes it at the right degree of importance in the synopsis, and that it is succinct yet covering all key aspects of that patient’s history. A system has to practice through a lot of context generation exercises to be able to get to that level. A nuanced feedback approach will fine tune it to ultimately provide a highly intelligent report that greatly. improves clinical efficiency.

 

Such reporting systems can serve as historical milestones in the patient’s chart in the EHR, organizing until it becomes a diligently maintained streamlined system. User experience will play an important role in creating a system that works in the background and generates such milestones (synopses), which are easy to access, fast to process, palatable to consume and overall, eases the burden of the clinician rather than further complicate the EHR.

Medical errors – how AI can help reduce them

There is a wide range of errors that take can take place in both the clinical and the nonclinical realms of healthcare. There have been a lot of interest in applying Artificial intelligence in these areas to see if it can be leveraged to reduce medical errors. Let’s review these potential opportunities:

 

Patient identification errors:

This is because of real concern. Every day, hospitals, pharmacies and offices face discrepancies in patient identification. This becomes an even greater issue in the realm of telemedicine. Online identity theft and fake accounts have made it quite challenging for telehealth systems to accurately identify patients as they provide consults to them. AI can play a role in these settings. It can process various sources of data that contribute towards establishing patient identity, such as face recognition, retina scanning, as well as electronic user history and social media profiles, etc. Early pilot products suggest using AI in some of these settings, especially in telemedicine (along with blockchain) can significantly improve patient identification and reduce critical errors.

 

Diagnostic errors:

A lot of research is emerging that shows AI transforming the face of diagnostic medicine. In the realm of pathology and radiology, AI is fueling computer-aided diagnosis and it is propelling the radiogenomics revolution. In the conventional sense, human-based interpretation is being matched by AI/ML driven interpretation, and in some cases exceeded by the latter. This helps in reducing human-based diagnostic errors by automating the process of segmentation, lesion detection, image analysis and interpretation.

 There is a very high incidence of errors in medical reporting

Procedural errors:

AI can streamline the protocoling and other workflow-related processes that can help reduce procedure-related errors in medical practice. This includes issues such as laterality checks, protocol selection, radiation doses, pharmaceutical agent selection, procedure type selection, etc. AI can help in ensuring several quality control checks as well that can also help in reducing procedural errors.

 

Medical reporting errors:

There is a very high incidence of errors in medical reporting. Radiology and pathology reports can have many errors that can lead to significant issues in medical management. AI-driven bots/systems can streamline the dictation and reporting process so that manual errors are reduced. Feature selection based reporting system, as opposed to completely free text reporting may be useful in terms of reducing errors and when aided by AI, it can be leveraged to generate semiautomate reports to an extent that they limit the scope of making errors and detects them when they occur

 

Coding & Billing errors:

Similarly, clerical errors such as incorrect coding and indication mismatches leading to billing discrepancy is another drain on the resources. AI can automate the process of coding and billing in a way that no or very limited human involvement is needed while ensuring accurate coding so that no claims are denied and all billing is seamlessly processed. There are a few solutions in the market that are leveraging this technology and it is beginning to show promising results.

3 Unbeatable Reasons to Outsource Medical Billing

Physicians and healthcare facilities are continuously battling decreasing reimbursement rates from insurance companies and rising operational costs. All these factors make medical billing critical for a physician or a healthcare practice.

 

While some practices keep the billing process in-house, an increasing number of practices are outsourcing the medical billing to a company that has expertise in medical coding and billing. Here are 3 reasons why outsourcing your medical billing can be the best practice for your healthcare facility or practice.

Faster Claim Processing

To optimize your cash flow, every claim should be paid quickly and accurately. Since in-house staff has enough on their hands, they do not have the time to examine and follow-up on every claim. However, these claims have to be submitted promptly and accurately. Healthcare providers outsource their medical billing to reduce the administrative burden on their in-house staff. Medical billing companies are not only quick but also accurate with the submission and processing claims.

High-Value Claims

When a medical practice staff is overwhelmed with billing and other administrative tasks, the quality of patient care may be affected. In addition, some healthcare practices may focus on larger high dollar value claims because they form a greater percentage of their cash flow. But these could create long-term complications.

 

The lower value insurance claims may become a write-off and that is not good for a practice’s bottom line. Practices need to identify and work on claims with processing issues. But back office support staff in a medical practice often don’t have enough experience to efficiently manage the billing process. Outsourcing medical billing allows your staff to focus on other important aspects of managing a practice, such as improved patient care.

Cost-Efficiency

Medical billing services are experts in medical billing. Years of handling medical billing and revenue management provides them with a specialized set of skills and deep knowledge of the industry. Skilled medical billing services has the required expertise, infrastructure and software to process insurance claims efficiently. This helps medical practices save a significant amount of money.

 

To learn more or to take advantage of the top specialty medical billing services, such as pain management billing or behavioral health billing services, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.

3 Revenue Cycle Issues You Can’t Ignore in Medical Practices

Many persistent medical billing and revenue cycle issues are detrimental to a medical practice’s bottom line. Most in-house billing staff simply reacts to problems instead of proactively preventing them. However, if your billing staff’s focus is on fighting urgent issues, they may be unable to identify the source of these issues. This would prevent building an efficient revenue cycle management system.

 

From processing first time claims to denial management and patient collections, the entire revenue cycle should work in a streamlined manner.

 

Here are 3 problems that medical billing departments face constantly.

Patient Collections

It is critical that patients be educated about the details of their specific insurance plan. All patients may not know exactly what their insurance actually covers.

 

The growth of high-deductible plans also makes it necessary that patients should understand their financial responsibility. If this education is imparted early, patients are likely to have a better overall experience. Better informed patients will trust you more, contributing to a better doctor-patient relationship.

Denial Management

Denied claims are a huge problem for most in-house billing departments. Denial management includes efforts to reduce denial rates as well as following up on denials, resubmitting them and getting them paid.

 

The fastest way to reduce denials is have clear and open lines of communication within the practice. You need to organize workflow in a manner that helps to prevent denials and manage them if they occur. Billing staff needs to be trained to minimize errors so that denials can be reduced.

In-house Staff

Your revenue depends, to a large extent, on the quality of your medical billing department staff. Hiring and training top-performing medical billers and coders should be taken seriously at any medical practice. However, this is one of the biggest challenges for many practices. In addition, you need great front office and/or administrative staff who understand the importance of patient focus and flawless billing and coding. In order to be able to do this, the medical office staff needs continuous training and coaching.

 

It can be extremely challenging to be able to hire and train the right people, consistently update technology and infrastructure and dedicate a large part of your time and energy to medical billing and coding. Yet medical billing is one of the biggest factors that can make or break your bottom line. This is why most medical practices have now outsourced their medical billing and coding to professional medical billing companies. These companies have the required software, staff and other facilities to fulfill your requirements.

To learn more or to take advantage of one of the top specialty medical billing companies, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.

Don’t Understand Medical Billing? You Might Lose Your License.

What’s the most important thing they don’t teach you at medical school? And yes there is a lot they don’t teach at medical school but arguably the most important point in your future practice is medical billing. Medical billing is incredibly confusing and the new ICD-10 has somewhere in the region of 70 000 billing codes. Remembering and understanding all of this are imperative to get the right fee for your service. This is often where medical billing services come in. The argument for medical billing services has probably been made to you a hundred times over, yes they improve revenue and cash flow and mean you get to spend more time with your patients, but you might not have thought about how the billing service industry protects you from fraud charges.

The easiest way to ensure a safe and accurate medical bill is provided to ensurers is to call in the professionals.

Yes, that’s right, medical billing services could actually save you from costly fraud charges that might leave you and your practice in tatters. But why exactly is this? Well, having a poor understanding of the procedures you are performing or incorrectly entering billing codes can have dire consequences, as Dr. Joseph Pober recently found out.

 

If you recall the name Dr. Pober that’s because he became famous for helping out a trump supported who was injured in a brawl. But now the New York Post is reporting he finds himself in trouble over incorrect billing. The Board for Professional Medical Conduct is set to hold a hearing about Dr. Pober that will decide whether or not Dr. Pober has his medical license revoked. Dr. Pober is currently the defendant in a fraud charge after he allegedly falsely represented a number of skin graft procedures he did. These “deviated from medically accepted standards” according to the state.

 

Clearly, a medical billing service would not have this kind of issue. Their service provides the correct billing codes for insurers as they are experts in medical billing who understand the process and intricacies of the American system. If a practitioner is left to their own devices with medical billing, incorrect charges can be levied on insurers. As we have seen in the tragic case of Dr. Pober, this may lead to the loss of a doctor’s license.

 

Therefore the easiest way to ensure a safe and accurate medical bill is provided to insurers is to call in the professionals.

Why is Accurate Medical Billing Important?

Changing regulations and stricter standards for medical billing and coding have made billing a bigger challenge than before. Medical practices seek improved billing solutions not only to get reimbursed fairly for the services rendered but also to be able to deliver the best patient care.

Need for accurate medical billing

Inaccurate medical coding and billing can cause various problems. It can result in claim denial and rejection, unhappy patients or even legal issues.

 

This makes it necessary to ensure that medical coding and billing processes are performed accurately and flawlessly.

 

HIPAA, ACA and other healthcare laws have been designed to protect patients by ensuring uniform standards and appropriate methods being followed by physicians and practices. This calls for eliminating the practice of inflating costs or inaccurate coding.

Role of Medical Coding and Billing Companies

Changes in health care-related laws and regulations have made it essential for medical practices and to follow the best medical coding and billing practices. Since this may pose a challenge since you are running a busy practice, many physicians have outsourced their billing to a professional medical coding and billing service. These companies have a large number of trained billing professionals who stay updated with prevailing standards and best practices. Outsourcing your billing ensures accurate coding and billing, timely reimbursements, increased revenue while you can focus all your attention on patient care.

 

To learn more or to take advantage of the top specialty medical billing services, such as behavioral health billing services, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.

Prevent Common Medical Billing Errors

The payment for medical services rendered is directly affected by the accuracy of medical coding and billing. Hence, physicians and medical practices can’t afford to have erroneous or delayed billing. It can seriously impact their bottom line.

 

Continuous updates in the health care industry require fast-paced changes and adoption of modern technology. However, these changes also add the likelihood of errors. This is why many healthcare practices have outsourced their medical coding and billing tasks to reputed medical billing companies. These companies have the required capabilities, such as trained staff and regularly updated software and technology.

 

Errors in medical billing not only impact your bottom line but also the patients. Errors can make patients face financial issues or being pushed to pay for services they didn’t receive. This can cause patient dissatisfaction which doesn’t bode well for any medical practice.

Common Billing Errors

 

  • Treatment and diagnosis code mismatch
  • Not justifying medical necessity
  • Entering wrong data
  • Duplicate billing
  • Careless use of balance billing
  • Failure to verify insurance coverage
  • Undercoding / upcoding
  • Unbundling services

Prevent Medical Billing Errors

Errors mean claim denials and rejections. Correcting claims and resubmitting them can take a lot of time and negatively impact a practice’s cash flow. Hence, it makes sense to prevent these errors in the first place. Verifying patient information, checking that diagnosis and treatment codes match, proper insurance verification and hiring a medical billing company with the right expertise can help you avoid billing errors.

 

To learn more or to take advantage of the top medical billing services offered by one of the best medical billing companies in Massachusetts, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.

Avoid Expensive Medical Billing Errors

The financial health of your medical practice depends upon the doctors, nurses, other staff and your image as a leading healthcare practice. Good practice management also needs to take into account whether there is any money drain due to scheduling issues, unpaid claims, or ineffective technology solutions.

Unfortunately, a large number of medical bills contain errors. You obviously want to keep them away from your practice. Billing errors can cost you a great deal. To avoid such errors in your practice, here are the most common errors you should watch out for.

Data Entry Errors

This is the most common coding and billing error. From incorrect patient information to misstating the number of nights a patient stayed at an in-patient facility, such mistakes can lead to the claim being denied by the insurance provider.

Coding Errors

Coding errors are equally frequent and can easily lead to denials. Coding errors include –

  • Diagnosis and Treatment mismatch – payers may deny a claim because the coding of diagnosis and treatment do not match.
  • Unbundling – the provider charges related services separately.
  • Upcoding or Undercoding – bills don’t accurately represent the services received by a patient.
  • Failure to verify insurance in advance

How Can A Practice Avoid These Mistakes?

  • Verify and double-check patient information
  • Always verify insurance beforehand
  • Use intuitive, easy to use software
  • Trained, skilled billing staff
  • Outsourcing billing to a professional medical billing service who have the latest technology and a large number of skilled staff to take care of your coding and billing needs. They can keep track of claims and denials in real-time. By reducing common errors, a medical billing service can help you preserve your bottom line.

To learn more or to take advantage of specialized billing services, such as behavioral health billing services offered by the best physician and medical billing services, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.