One Big Happy Family
By Melody W. Mulaik, MSHS, CPC, CPC-H, RCC, PCS, FCS
Do you feel it? What is “it,” you ask? “It” is
the day-to-day stress that healthcare professionals feel to provide excellent customer care with fewer resources. Less
staff, less money, less of any and everything with no hope in sight of things significantly improving in the short term.
We live and function in an ever-changing
environment that requires us to adapt on
a regular basis. If we don’t, we will either
burn out or become irrelevant, which
ultimately leads to our professional
demise. There are many other resources
that you can consult to avoid burnout so
that will not be addressed in this article.
Professional relevancy, however, is a key
component of this article. How do you
ensure that you are addressing all aspects
of your job responsibilities and planning
for future opportunities that may become
There has never been a more critical
time to focus on the relationship between
radiologists and hospitals/facilities. Many
radiologists are becoming hospital employees, which changes the dynamics of both
organizations. This may streamline the
number of administrative staff and require
integration of key management functions.
If presented with the opportunity to either
manage or support the radiologists’ functions, are you adequately prepared? Do you
understand how their needs and requirements differ from your facility’s? It is
impossible to address all of the potential
issues that this raises so I will focus on two:
matching facility and physician charges
and identifying areas of concern in both
facility and professional billing.
Many radiologists are becoming hospital employees, which
changes the dynamics of both organizations. This may
streamline the number of administrative staff and
require integration of key management functions.
With the implementation of the Medicare Administrative Contractors (MACs)
we now have a single contractor for each
geographic region that performs all core
claims processing operations for both
Part A and Part B. These MACs are able to
match hospital and physician claim data.
In some regions, we are hearing reports
of radiologist claim denials due to the
fact that they do not match the codes
submitted by the hospital. Which one is
correct? The physician? The hospital?
Maybe neither. While some would argue
that physician coding has the greater
chance of being correct since the codes
are usually assigned by reviewing the dictated report, an across the board assumption of accuracy cannot be substantiated.
How can we ensure that both the hos-
pital and the physician have appropri-
ately billed for the performed (and docu-
mented) services? While there has been a
more concerted effort to match interven-
tional charges between the physician and
hospital, this has not always extended to
diagnostic services such as CT, MR, etc.
In many organizations there is a prevail-
ing assumption of accuracy (that may or
may not be confirmed) or lack of regard
for “the other side.” This statement is not
meant to infer a lack of concern or care
but rather the frustration of recognizing
that it is easy to identify problems but
much harder to ensure resolution of bill-