In medical imaging when a procedure is performed, like an x-ray, the images and physician notes are stored digitally in one software system. A report is sent to billing, who uses another software system to assign a code to be able to send the bill to the payer, typically Medicare or insurance companies. This is an important part of the business because significant costs were incurred to provide the services and the incoming revenue is the life-blood of the company. Recently a radiology group knew that they were having problems with their billing process. The number of procedures was constant but revenues were declining over the previous few months. They needed a way to compare millions of transactions from their billing and image databases. This started the development of software used by Bern Medical to reconcile the billing traffic. Bern uses its proprietary software to reconcile what has been done to what has been billed. This radiology group discovered that over the previous 18 months they had missed billings of $4 million. They resubmitted the charges to the insurance companies and were able to recover $2 million. Development of the analytical software began in 2009 and undergoes constant revision to improve the algorithms and the results. During the initial development and testing another 12 groups used the services and were able to recover an average of 2% of their annual revenue. In August 2011 Bern Medical, a San Diego based company, was formed to take the services to market across the country. To perform the analysis a provider uploads a data export from their systems to Bern's HIPAA compliant server. Bern then performs the analysis and delivers back a report of missed opportunities and analytics that can help the provider correct the errors going forward. The founder of Bern Medical is David Fuhriman. He graduated from Boise State University with a degree in Spanish and Economics. He earned an MBA from Northwest Nazarene, is a California licensed CPA, and a Six Sigma Greenbelt. Recently he worked at a fast growing San Diego based telecom company. During his 5 year tenure revenue grew from annualized revenue of $20M to over $160M. David was responsible for business intelligence, financial consolidation and development and maintenance of corporate budgeting. David says the most important thing is that its services are risk-free and doesn't cost anything out of pocket. "Our proposition is that we provide an independent billing review for free. If we discover that the billing process is perfect, then our clients pay nothing. We only take a fee based on dollars we actually help recover. So it is a win-win situation." When asked if this means that it is an easy sale, David replies, "Yes and no. Many people see the value immediately. When some don't they usually fall into one of two camps. The first is the assumption that they don't have any errors. The second is that they are afraid that we will expose the errors that they have personally made. The answer to both of these concerns is that there will always be errors. We expect to find a 2% error rate. This means that there is a 98% accuracy rate." Will or can an MRI indicate ability? Could we have to submit to an MRI to determine whether we would perform well at a job or even as entrance criteria to a university program? Here is the abstract on a recent study trying to discover the answers. "People differ in their ability to perform novel perceptual tasks, both during initial exposure and in the rate of improvement with practice. It is also known that regions of the brain recruited by particular tasks change their activity during learning. Here we investigate neural signals predictive of individual variability in performance. We used resting-state functional MRI to assess functional connectivity before training on a novel visual discrimination task. Subsequent task performance was related to functional connectivity measures within portions of visual cortex and between visual cortex and prefrontal association areas. Our results indicate that individual differences in performing novel perceptual tasks can be related to individual differences in spontaneous cortical activity." I am doing a little catching up on "independence" guidance per AICPA guidelines (American institute of CPAs). The basic theory is that providing attestation services (reviewing financial information to verify to its accuracy)- that these services should be independent of the client. That there are inherent conflicts that can arise when a CPA is not independent. For example, if I owned a company that I was selling to you- if I told you I was a CPA, so you should trust me that the financials are accurate, would or should you trust my opinion?
No. You should not trust my opinion, because there is not independence in appearance or in mind. We may not be held to the AICPA standards of independence, but we hold to the values. Bern Medical provides a review of the procedures performed to discover certain procedures that were never billed. We are independent of the billing company and of the provider. We just care about discovering opportunities and/or verifying that all items were captured. Can a similar review be done by the billing company or the billing department? Of course, if they developed or acquired the technology or spent significant time. Auditing selections could also be made to help make discoveries. But when you are around 98-99% capture- you likely won't discover anything through selections- let alone all items that were missed. But the real problem with having the review done by people that perform the billing function is independence. Stated from AICPA section 100-1 on Independence: Independence is defined as:
Great TED video about working and finding something you are passionate about. Worth the watch. I will probably be writing about this on DiagnosticImaging.com so I will just link to it here. Interesting new tool for Correct Coding Initiative and Medical Unlikely Edits.
http://medcomplianceservices.com/cpt I have written before about corporate culture and its impact to morale, productivity, and customer satisfaction. Nothing in life is a silver bullet, of course. But, culture matters. And what is demonstrated from leadership will resonate with everyone else in the group. Greg Smith of Goldman Sachs- of course you have not heard about him before now- but he was Executive Director of their derivative business in Europe, Middle East and Africa. He has been there for 12 years. Please read his resignation letter, published in the HY Times, indicting the change in the corporate culture at Goldman to be too focused on making money for the company, at the expense of best interest of the clients. Read: Here
Wanted to share a quick customer experience with you:
Recently Bern Medical analyzed the billing data for a company with 12 different MRI locations in the Midwest. The client uses a very popular and well respected billing company. Bern performed its analysis for the past 12 months, from January 2011 to December 2011. Bern discovered a very effective process but that the billing company had missed charges on particular days and then continued capturing all charges again. For example, for 3 days March 3, April 13 and October 6, 2011 nearly 150 MRI exams were never billed spanning across all locations. For all 12 months Bern discovered and verified 1% of annual volume was never billed. The client then processed through normal billing channels the missed charges. Bern's analysis allowed the MRI center to collect on $140k ($300k gross) of missed revenue opportunities. I had a great idea this morning: Why not use Photoshop to modify medical images, like X-rays, and fix the problems. Now that most images are captured digitally, it would be fairly easy.
See, when I was in high school I played soccer and two weeks before tryouts I was playing in the park with some friends and a nasty two-legged tackle hurt my leg. I went to the hospital for an X-ray. As a result they put a cast on my leg for two months. I missed tryouts, but the coach still selected me to play on the JV team. I ended the season as the top scorer so that was good, but my point is if my X-ray images were digital and someone had used Photoshop to modify the image, I wouldn't have needed the cast. I would have been selected for the Varsity team and well, most likely would have had an amazing professional career in Europe. As I think about it more, I realize all the great things that we could do in medicine if we could just modify the results with Photoshop. Think of the costs we would save and of course the impact on our lives. We could stamp out cancer very quickly. Think of what an amazing world we would live in, if we could just Photoshop medical images. This is, of course, a preposterous proposal. The image is not the cause of the broken bone or the cancer. Of course the treatment I received for my broken bone, while an inconvenience, was better than the alternatives. (Although it did cost me a win in the World Cup for the USA in 2006.) Do we sometimes in our private and professional lives ignore the evidence because we don't like the answer or the solution? Of course. When my wife hears an odd sound in her car, she doesn't try to investigate it, she just turns up the music so she doesn't hear it. In October 2008, when the stock market took a huge drop, I refused to look at my 401(k). I didn't want to know the damage and I didn't want to have to think about my portfolio allocations and changes I should have made to recover better. I have also seen the issues professionally. I worked at a place where one of the employees would regularly fall asleep at work. By regularly I mean everyday at his desk between 1 p.m. and 3 p.m. It was common knowledge but nobody did anything to help. I don't think he should have been fired, but everyone acted like it didn't happen. That sent a huge message throughout the company. In the work I do now I see people effectively Photoshopping medical images. I help radiologists discover missed revenue opportunities. Usually people have two thoughts going through their mind: First, "I don't think that you will find anything." Second, "I hope you find a lot." I recently had a conversation with a director of radiology in a hospital and his response surprised me. He didn't want my company to do the analysis because he didn't want to do the work when we returned with a list of billing opportunities that the hospital could submit. I had no answer to that. At RSNA I was talking with a billing company that specializes in radiology. I explained what I do. Their response? "We guarantee that we capture 100 percent of charges." I was surprised that they could guarantee that. "Well, virtually guarantee almost 100 percent." Well sure. If you ignore what you miss, then I guess you capture everything that you captured. We live in a chaotic, unpredictable and random world. In medicine, business and life we will find things that we wish hadn't happened and things we didn't want to know. We do things we wish we hadn't and we make mistakes. It is part of being human, I guess. But, just because we can Photoshop the image doesn't mean we should. The new post came out today. I like this one, it is an interesting read. Check it out:
What If we Photoshopped Medical Images on DiagnsoticImaging.com's blog. |
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June 2013
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