Make referring physicians your allies

Oct 8, 2000

Referring physicians can become allies in the mammography reimbursement war when they're educated on the appropriateness of various imaging exams and when they should be ordered.

"They can’t just say ‘Do a screening mammogram and if you find anything, do a diagnostic mammogram and an ultrasound.’ They must provide an appropriate clinical diagnosis," Linver said.

One way to facilitate the process is to supply clinicians with a well-designed exam order pad. In Linver’s practice, the order form includes a list of every breast-related procedure, a checklist of breast problems the patient may be experiencing, such as pain, a lump, or nipple discharge, and a diagram where the primary-care physician can indicate potential problem areas.

"It makes the order form a little longer, but it’s well worth it so that you don’t have problems in the future," he said. Discrepancies between the physician’s order and the imaging services rendered make it easier for payors to delay and deny payment, he added.

Another weapon a practice can wield is an internal audit. Keeping track of the quality of care gives radiologists information they can use to renegotiate reimbursement rates with an HMO.

At X-Ray Associates, Linver and his colleagues kept a seven-year tally of their screening mammography and demonstrated that they were catching more cancers at an earlier stage, resulting in less treatment.

"Show the HMO that you are saving them money, because that’s all they care about," he advised. "Use your success in breast imaging to your advantage."

In addition, a data audit can help a practice keep track of any billing mistakes that could mean a payment denial. This kind of self-policing can keep a practice off the Medicare "hit list," he said.

"This requires vigilance, commitment, and follow-up," Linver concluded. "But if we don’t figure out how to ensure reimbursement, we’ll really crash and burn."

By Shalmali Pal
AuntMinnie.com staff writer
October 9, 2000

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