Challenges in Medical Billing Industry And How to Deal With Them

Radiology practices and imaging centers face many threats to their profitability. Radiology billing is becoming even more complex, and reimbursements are steadily decreasing. There are three key challenges you'll need to understand and address for your radiology business to thrive in the coming years. The future is less. Bundling of services and codes has already resulted in lower (and in many cases significantly lower) reimbursements for providers. Some revised codes carry lower RVUs, reflecting the belief that those services were previously "misvalued" (overpriced). The Medicare Payment Advisory Committee (MedPAC) recently recommended measures to further reduce imaging reimbursements, including lowering the threshold for bundling review from 75% to as low as 50%, reducing professional component payments for multiple procedures and studies conducted by the same practitioner during the same session, and discounting payments for providers who both order and read images. Some "thought leaders" (see the Radiology Business Journal June/July 2011) think that professional component reimbursements are likely to decrease another 30% over the next five years. Complexity is increasing. Impending new coding procedures will affect both clinical and business operations. New compliance requirements will further affect radiology billing procedures. And then there's the move toward more electronic data standards and requirements. With ICD-10, coding isn't simply being refined and updated. New codes will be longer, and there will be a lot more of them. RVUs will be different, too. Since you won't see much matching between ICD-9 and ICD-10, your staff will have to figure out how to accurately "translate" to the new world. Of course, we can count on the government to keep working to "correct" pricing, uncover new bundling opportunities and eliminate overuse of procedures. You'll also see more emphasis on linking radiology billing and reimbursements with outcomes measurements, expanding on initiatives such as PQRS (was PQRI). Change is the new normal. Your in-house costs are going up. Daily operations costs will keep increasing, and incorporating new radiology billing requirements will add cost pressures to your financial situation. Coding and billing staff will have to learn an exhaustive new ICD-10 coding system very quickly. Even after the October 2013 change-over deadline, providers will have to continue processing ICD-9 codes for services rendered before the deadline. Since payors will have an extended deadline, you may face additional "dual" processing issues. This will create more work for your staff and possibly unwanted reimbursement consequences, too. New, more involved ways to link financial data to reimbursement will require more sophisticated technology and better trained staff. Failure to accurately document patient data, including benefits details, could result in increased denials, even fines. Annual planning and budgeting may be tougher, because the ICD-10 timeframe doesn't announce changes until October, giving you less than three months to prepare for the next fiscal year. These radiology billing challenges mean even more attention to the ever-changing coding and compliance requirements. And you'll have to manage the business side of your practice or center smartly and efficiently to remain competitive and prosper.