As more and more hospitals re-engineer their outreach efforts, acquiring freestanding imaging centers remains a key component when developing an ambulatory strategy. Today, patients are looking for cost savings and convenience—a full 80%+ obtain their healthcare services in an ambulatory setting. Hospital systems that are able to provide services close to where a patient
lives and works will ultimately win their overall business and succeed in a value-based payment environment.
Outpatient radiology programs that are housed on the hospital campus continue to look less attractive to patients who demand easy access to services. By acquiring imaging centers that are in convenient areas, easily accessed by patients, hospitals can not only capture the actual business but also build supportive and mutually beneficial relations with referring and admitting
physicians in their catchment area.
Will Acquiring Imaging Centers Impact Hospital Receivables?
Stepping into the ambulatory arena brings significant challenges, including global billing considerations and the transition from hospital billing practices to an outpatient imaging center. Specifically, the way billing is handled in the hospital setting is diffused by layers of admissions and billing office personnel. In an outpatient imaging center, with its streamlined check-in process, the following functions deserve special consideration to avoid ballooning AR and claims denials:
- Insurance verification and eligibility—The healthcare payment lifecycle begins with an accurate recitation of patient demographics, insurance coverage and eligibility, and out-
of-pocket dollar amounts available. Without precise verified information the whole process breaks down into an avoidable cycle of manual rework and follow up.
- Determining patient responsibility due and collecting at the time of service—Informing patients of their copay or co-insurance and collecting as they arrive is key, particularly in
an off-campus imaging facility. Patients who receive bills for portions due well after the fact are often unmotivated to pay. These amounts will linger in the AR, dragging down
your days outstanding unnecessarily, while also potentially damaging the patient relationship.
- Prior authorizations (PAs)—Originally intended as a utilization management and cost containment tool, PAs have grown into a behemoth that 91% of physicians say negatively impact patient outcomes. Besides creating scheduling and administrative nightmares, PAs take time away from the patient and add to the denials management workload.
- Clinical Decision Support Mechanism (CDSM)—As in the hospital setting, certified compliance certificates are required for many advanced imaging orders and non-compliance puts revenue at risk.
What Can Be Done to Minimize Receivables Damage?
A stand-alone imaging center looks the same to patients from the outside, but without adopting strong outpatient billing practices, hospitals run the risk of compounding denials and expanding
receivables. Best practices suggest leveraging automated technology that uses solutions supported by Artificial Intelligence (AI) and machine learning. Both AI and machine learning reduce manual workflow and can be assisted by third-party outsourcing—allowing you to scale up or down as required to meet the flux of patients.
The solutions now available through AI and predictive analysis technology are driving automated improvements at hyper speed with PA and its corresponding cousins, insurance verification, co-pay collection, and CDSM, leading the way in the healthcare payment lifecycle. Integrating AI into the provider data RCM workflow creates an organized and efficient process that automates submission, follow up, and notifications into a seamless effort that reduces rejected claims and accelerates the reimbursement cycle vastly improving overall analytics.
A survey from Healthcare IT News and HIMSS Analytics noted that 35% of healthcare organizations have a two-year timeline on implementing AI system-wide, with another 40% poised in the following 2-3 years. Innovative thinking in this new age of technology has lead to hospitals evaluating how they do business and what improvements are now available that will drastically improve their bottom line while also enhancing the patient relationship.
Contact us today for more information on AI-enhanced and automated radiology and imaging center RCM solutions.