Order up!
With the varying payor guidelines how does a facility handle orders? There is not one correct answer. Each organization must consider its operational structure and flow. Additionally, you must think about the compliance concerns as well. In most audits the reviewing entity will usually request a copy of the exam order in addition to the radiologist's dictated report. If the information does not match, there can potentially be financial consequences. As you think about your current process, how is information received into the facility, what information does the technologist have access to and what should be the roles and responsibilities of each team member that are part of the process? Should the technologists be worried about what insurance the patient has or should all patients be treated the same? Various questions must be considered and balanced with patient care. Many facilities have chosen to follow Medicare guidelines, even for hospital patients, since their adherence will generally ensure compliance with commercial payors and ensure payment when pre-certification comes into play. Compliance with order requirements for all payors is not optional--how an organization achieves this compliance is where the variations begin. "But that's our protocol" is not a valid argument in the event of a payor audit.
Coding Strategies, Inc., USA. melody.mulaik@codingstrategies.com
Melody W
MW
Mulaik
D059019:Clinical Coding; D003952:Diagnostic Imaging / Q000145:classification; D006801:Humans; D007344:Insurance Claim Reporting; D006278:Medicare; D011872:Radiology Department, Hospital; D014481:United States