Your practice's billing data can help you improve patient care and manage your practice. Here's how to extract this valuable information and make connections across disparate datasets.
It is an eat-or-beeaten world out there as radiology practices search for the winning formula of services, systems, and practices to survive in a volatile marketplace.
Demonstrating value in a market where there is increasing commoditization, creating a positive patient experience in an environment where a radiology practice has little opportunity to interface directly with patients, and forging a partnership with emerging coordinated care delivery systems are just three examples of the complex challenges we face today. As the practice management challenges for radiologists continue to grow more complex, understanding how to leverage enhanced revenue cycle management technology and business intelligence will be critical for demonstrating value and having actionable data to support informed business decisions.
Health care’s future is based upon sharing patient information across the continuum of care. Practices that are capable of providing data previously locked in stand-alone data silos to their customers of the future — such as accountable care organizations and other coordinated care models — as well as to traditional customers like referring physicians, will find themselves at the top of the food chain.
The RCM as the Data Mart
The old-paradigm “billing system” has evolved over time into a revenue cycle management (RCM) system, but many are still glorified bill generators that are patched together with other applications and that fail to properly address the key requisite of health care today — interoperability. This failure to dynamically share communications, information, and services with disparate and distributed systems when, where, and how the data are needed, necessarily limits the RCM systems’ role. Cohesive, interoperable platforms are needed not only for effective revenue capture and management, but also to serve as a radiology practice’s central financial and information hub — a critical enabler for making timely and informed decisions, both operational and financial, that may impact the financial viability of the practice.
Fortunately, continued technological advancements now allow radiology providers to connect electronically to support clinical and financial information exchange. The RCM now needs to function as the heart and soul of the radiology practice, able not only to communicate in real-time with referring physicians, patients, and payers, but to amalgamate data from stand-alone silos. Radiology practices armed with the business intelligence needed to consolidate data to drive sound decisions will be best positioned to add value and thus thrive.
In the current climate of accountability and government regulation, providers need to make the most of data. Radiology administrators need to strategically manage their practices with information that identifies workflow trends and processing bottlenecks, along with the ability to produce a variety of on-demand fiscal and operating reports.
Business intelligence (BI) is defined as using a computer-based approach and data repository to collect and analyze information about business processes and trends, allowing health care providers to track and manage key performance indicators that highlight opportunities for improvements or efficiencies.
But all data are not created equal, and business intelligence is not just about pretty dashboards. Practice managers require on-demand, actionable data when and where they need it. Reliable underlying data, meaningful performance metrics, and cross-system analytics are needed to bridge the gap between disparate data systems to provide greater clarity and control of business operations.
Most of the RCM systems available today provide or can be integrated with a report generator to track indicators such as denied charges, net collections, and accounts receivable aging. But these reports are often far from intelligent. They may be inaccurate, based on improper or poorly-constructed data, or so untimely that they cannot be used to drive action. Often they cannot be trended on a daily basis so that problem areas can be quickly identified and addressed. They may be mired in such detailed minutiae that it becomes difficult to spot a trend at all. Legacy systems’ reporting limitations often make it difficult to extract required data, and it can take weeks or even months to code and generate a new report. Radiology managers can be overwhelmed with data, yet lack good information to make the best decisions. Without access to integrated information that is updated on a continuous basis, it is difficult to look at long-term trends and get a big-picture view to make proactive decisions rather than react after the fact.
True business intelligence uses data from multiple sources and systems, regardless of size and source, and transforms them into snapshots to create dynamic answers to the questions being asked of radiology providers today: What drives the quality of our care? How can we improve patient satisfaction?
True cloud-based RCM solutions include access to BI solutions that put analytic capabilities and digital data dashboards at the fingertips of radiology administrators without the need to involve the IT department. As health care reform initiatives and coordinated care models like ACOs gain momentum, access to timely business intelligence becomes critical to demonstrate quality and appropriateness of care to patients and third-party payers to ensure reimbursement. Radiology practices that understand their business and are able to provide merged clinical and financial outcomes data will have a distinct advantage in reimbursement and/ or exclusivity negotiations with ACOs and commercial payers.
Cloud-Based Web Services
A cloud-based platform is designed and built from the ground up to be delivered over the Internet using standard Internet protocols (e.g., REST, SOAP, and HTTPS) and health care interoperability and security protocols (e.g., HL7, 5010).
New web service technologies provide a standard means of connecting different software applications, running on a variety of platforms via a secure Internet protocol. This opens the door for realtime data exchange regardless of operating system or programming language, between software applications being used at hospitals, imaging centers, and payers, thereby ensuring proper charges, compliance, and reimbursement.
While traditional billing systems have achieved some degree of integration, they are not truly interoperable; they require hard-coded static interfaces that are difficult to maintain, and they cannot communicate in real-time or be easily altered to integrate new information-sharing systems.
Cloud-based web services can be called from other applications to integrate over the enterprise. A web services call is real-time, eliminating static daily HL7 imports and creating true data-sharing opportunities between disparate and distributed systems.
Next-generation RCM platforms use real-time cloud delivery to continually push changes in regulatory standards, software updates, and payer edits automatically, with no disruption to radiology billing providers, a capability unheard of with traditional billing systems.
Many applications already used in radiology have successfully migrated to the cloud, such as PACS and RIS.
Software is often considered out of date the day it is installed, but cloud-based delivery means the system can be continually updated and kept current, both in terms of software and hardware and — particularly critical in radiology billing — in terms of financial, legal, and workflow infrastructure.
When a standard is updated or rules or procedures change, all relevant systems must be quickly and consistently updated. At the claim level, a cloud-based RCM platform can give real-time payer edit updates at the time edits are made, changed, or removed.
RIS or CPOE systems would not readily have the ability to interact with a billing system or know if a patient were eligible for services. True web-based interoperability allows radiology providers to share data with other applications in a digital conversation, a two-way real-time exchange of information that ensures all parties are in sync.
Interoperability is the dynamic that ensures when new information is entered into a physician’s desktop or RIS, the same information is made available in other applications to support the billing process and business intelligence. One example of the importance of this real-time data exchange is the need to have current information at patient payment points. If a patient accesses a bill online and makes a payment, and that system does not promptly reflect the transaction in the billing system, the patient may be sent to collections in error. The result is additional work and correspondence; more importantly, it may create patient dissatisfaction. Likewise, if new information comes back from a payer, such as up-to-date secondary insurance information, it can be automatically captured and used to trigger action in other systems.
A true cloud-based platform can impart additional value to modern EMR, practice management, PACS, RIS, and CPOE systems by allowing payer edits, eligibility checking, error processing, and correspondence to be handled at the referring physician’s office or front desk. Embedding the billing functions within systems outside the billing department will increase the value of these systems, reduce the number of front-end errors, allow for easier error processing correspondence, and ultimately result in cleaner claims and improved revenue collections.
Cloud-based platforms impart a higher level of integration to disparate systems beyond simple interoperability. From a governance perspective, this is important in avoiding unsynchronized data between systems that can result in denials or fines. From an organizational perspective, the overhead cost savings made possible by switching from manual reconciliation across various systems can be enormous.
While in the past it was acceptable to connect billing functionality only to a RIS and perhaps the general ledger, today the complexity is exponentially higher, and practices need to communicate with PMS, EMR, RIS/PACS and directly to patients themselves.
It’s been said of building the integrated health care delivery models of the future that if you’re not at the table, you’re on the menu. A cloud-based RCM operating as a business intelligence hub addresses the increased demand for data and how to keep from being buried underneath that same data and stay focused on taking meaningful, informed action. Radiology practices thus armed can ensure that they’re not only at the table, but that they help determine the menu.
By David Byrd