• Thomas Maher

Advice for Radiology Practices Working with Urgent Care Centers

Increased patient demand and an infusion of capital from private equity firms, insurance carriers and healthcare systems has fueled the continued growth for urgent care practices across the country. According to the Urgent Care Association’s 2016 Benchmarking Report, there were 7,357 urgent care centers in the United States, an increase of almost 10% over the previous year. This growth offers significant opportunities for those who provide ancillary services, including radiology practices.

Practicefirst provides coding, billing and practice management services for urgent care centers (UCCs) and radiology practices. We strongly advise radiologists who provide over-reads remotely for UCCs to negotiate a flat fee arrangement for this service rather than billing the professional component. Let’s look at why.

The initial x-ray image interpretation is usually conducted by a provider at the UCC. To avoid malpractice liability, most UCCs contract with an off-site Board-Certified consulting radiologist for over-read for confirmation or correction of the provider’s preliminary diagnosis.

When an UCC performs an x-ray, there are two billing components: the technical component includes the services of the radiology technician in the use of equipment and processing images, and the professional component for the radiologist who interprets the image and gives a written report.

In a fee-for-service scenario, the UCCs bill for the technical component and radiology practices bill for the professional component. The radiologists must negotiate and enroll with each insurance carrier, code the service and bill the claim, placing full responsibility of reimbursement for their work on themselves.

Problems arise because the radiology practices have no control over the patient experience and may not have access to the electronic medical records or billing software. If a patient’s insurance is incorrect or inactive, the radiology practice must seek the correct information by other means such as searching insurance websites for eligibility or billing the patient directly. This delays billing and results in additional costs for the radiology practice. Inefficiencies exist because these problems must be addressed by the UCC and the radiologists' billing staff.

Another example is when a patient’s deductible has not been met but no payment is collected at time of service for the professional component. When attempting to collect additional monies from a patient, radiologists must explain to the patient that there is a technical and professional charge and they may owe a balance to both provider groups.

In a flat-fee scenario, UCCs bill globally (billing both the technical and professional component) and receive reimbursement for both the actual taking of the image and the over-read with one code and one bill. The consulting radiologists negotiate a flat fee for their service with the UCCs and receive payment from them.

Global billing by UCCs for x-rays benefits radiology practices because the radiologists are contractually guaranteed to receive payment for their work, they save administrative costs (coding, billing and collections) and they have a consistent and fair revenue stream.

Global billing also benefits:

  • Patients because they are not liable for multiple co-pays, and they are not surprised with bills from a radiologist they did not see in person;

  • Insurance carriers because they process only one claim;

  • Urgent care centers because they will have a streamlined coding and billing process, higher reported revenue and improved patient satisfaction.

Practicefirst: Do the Right Thing

If a radiology practice takes our advice, they would eliminate the need for our coding and billing services for urgent care over-reads. So why would we recommend this? Because it is more efficient and less of a burden on the patient. With the rising cost of healthcare, it doesn’t make sense to pay for coding, billing and collections twice, resulting in unnecessary administrative costs including the patient possibly receiving two bills.

Practicefirst’s mission is to maximize the value of our clients’ medical practices. If that means making a recommendation that benefits them more than us, we’re happy to do so because we know that integrity pays off in the long run.

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