Claim denials drive up the cost of healthcare and divert resources from the primary goal of delivering quality patient care. When it comes to radiology services, the vast majority of claim denials can be attributed to insufficient documentation of medical necessity for three types of studies.

Claims management is essential to patient care. If a facility is not properly reimbursed for medical services rendered, patient care will ultimately be compromised.

Hospitals and clinics are integrating more tele-services into their everyday protocols as the telemedicine model continues to demonstrate the potential for them to deliver better, more cost-effective care. However, while new protocols for providing quality care are rapidly evolving, many organizations continue to follow internal credentialing bylaws and standards developed to support a dated paradigm.

Patient safety is the name of the game in credentialing. It is a process essential to ensuring quality care. However, the traditional primary source verification (PSV) approach to credentialing is antiquated in the age of telemedicine.

As the CIO of Radiology at MEDNAX and vRad, I cannot help but reflect on the history of imaging informatics – and look ahead to the future innovations that emerging technology will bring.

Radiologists must design protocols that enable clinical partners to achieve stroke certification. Medicine is at the forefront of a revolution in stroke diagnosis and treatment, as my colleague Dr. Dym elucidated in 2018. 

Effective collaboration with your referring physicians can make the difference between getting paid or not getting paid. Cooperation between referring and ordering professionals becomes increasingly important with the approaching implementation date for the Protecting Access to Medicare Act, on January 1, 2020. 

Today we have the capability—unparalleled in human history—to compile enormous amounts of information, then apply sophisticated analytic tools and artificial intelligence to help solve patients’ most vexing difficulties. Managing big data is essential to building specialized centers of excellence, and diagnostic imaging is a vital part of their success.

Patient expectations have changed. Rising healthcare costs are driving patients to demand more information when confronted with a medical issue, and technology is empowering them with access to that information. Today, radiologists are much more likely to interact directly with patients, where previously clinicians mediated imaging reports.