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How does the
RadPayor connect to our hospitals and imaging centers?
Short answer: By Hl-7
connections to hospitals HIS, RIS, and PACS.
Details: We are able to
connect to most any healthcare computer system. Besides Hl-7, this
includes receiving files in the following formats; .txt, .doc, PDF,
XML, CSV, and others. If you presently obtain good data we will
likely continue that source and format to minimize any disruptions or
changes. We have worked with institutions that were still printing
reports to paper. When we show them how to save thousands of dollars
in printing costs, they are very eager to convert to “print to
file” rather than “print to paper”.
What if we already
have Hl-7 connections with our hospitals and imaging centers?
We will just use those
existing formats to route the data through the RadPayor and then send
it on to its original destination within your existing billing
system. However the data would already be fully coded and ready to be
sent directly to submissions. Rather than the data coming directly
from the hospital to your system, it would just make a loop through
the RadPayor program and then go on into your system as it does now,
but fully coded.
If we want to
upgrade our billing software also, do you offer package deals?
Yes. We work closely
with billing software companies and can put together package deals
where the two systems work seamlessly together with reduced costs.
How much should I
budget per procedure for a US based RCCB coder?
Short answer: Ten
cents. (U.S. based companies providing RCCB certified coders).
Details: The average
United States RCCB RadPayor coder is compensated approximately 10
cents per procedure. This may appear to be unfair compensation by
those coders that are not familiar with the RadPayor program.
However, with productivity standards at 350 to 500+ procedures per
hour you can see that the coder is properly compensated. ($35 to $50
per hour) Those offshore outsourcing companies that are familiar with
the RadPayor’s performance also will offer proportionally
reduced rates.
How many FTE coders
will I need if I utilize the RadPayor?
The average RadPayor
coder will code 500,000 procedures per year. Take the yearly number
of procedures performed, divide by 500,000, and that will give you an
estimate of the number of full time coders needed.
How long has the
RadPayor program been utilized in the real world?
The RadPayor program
like any software is always in active development. It became a
specialty specific program about 7 years ago and is utilized by
clients across the states and offshore.
Do you offer coding
and/or billing services?
No. We do provide
references and referrals to companies and Independent Contractors
that utilize the RadPayor and appear to offer reliable quality coding
services at competitive prices.
What software or
hardware must be purchased to implement the RadPayor?
Only your coders will
require a vertically oriented monitor. No other software or hardware
is required as the RadPayor is a cloud based service. Users can
connect to it using any internet capable device including i-Phones,
i-Pads, Kindles and other smart devices. We recommend Dell’s
UltraSharp 2007FP or any quality 1600X1200 monitor capable of being
used vertically.
Is the RadPayor
system designed only for larger radiology groups?
No. It is remarkably
scalable. A single coder is all that is necessary to fully utilize
the system. However, the system is SQL based and has the ability to
allow your coders to process millions of reports per year, including
the concurrent interaction of managers, clerks, techs, PACS
administrators, and physicians. For all practical purposes there is
no upper limit as to what the system can handle.
Does a coder always
look at every single report before it is processed as a claim?
Yes, but that is a
choice and not a requirement of the system. All of the productivity
numbers are reported with a coder reviewing every report. We refer to
this as using the program in “Manual Mode”. Some clients
may wish to send some studies such as screening mammograms and bone
density studies through the system without having it reviewed by a
coder. Other clients may allow all of the “Green Lights”
to pass through the system without review. It is each client’s
choice as to how they wish to utilize the system.
What are the costs?
There is a per
procedure charge and a monthly maintenance fee. The “procedure
charge” is based upon volume discounts and the maintenance fee
is based upon the number of users and interfaces. If your group
performs 10,000 procedures per month; then multiply the “procedure
charge” times 10,000 and then add the monthly maintenance fee.
You will receive an invoice at the end of the second month of using
the system which will cover the previous 2 weeks of use. There are no
charges for the first 6 weeks of use.
Is the RadPayor only
for radiology?
Unfortunately yes. Even
though the LCD, NCD, CCI edits, and ICD-10 conversions are universal
and the system can process any specialty, the additional programming
for RAC violations and etc. is for radiology only. To be the best at
what we do, we concentrate only on one specialty.
How can I
realistically estimate what I should be able to save by using this
system?
Expect it to replace 7
out of every 8 FTE involved in the coding and data entry of radiology
reports and patient demographics.
Expect it to replace
all of those FTE involved in the gathering, sorting, alphabetizing,
scanning, OCR, faxing, emailing, archiving, and retrieving of
radiology reports.
Based upon your specific billing software;
Expect to eliminate your “small balance write-offs.” (up to 90%)
Expect to increase your collections.
Expect to reduce your mailing costs (up to 90%)
What is the expected
ROI?
Greater than 400%. Due
to a unique payment structure, an “investment” is never
required. Invoices for RadPayor services do not start until the end
of the second month of utilizing the system, with the first 6 weeks
of use being free. This allows your company to start accruing the
cost savings of utilizing the software before you start to pay for
its use. The savings are greater than the cost of the RadPayor
services by a factor of at least 400%, but again there is no
investment involved. It’s like having already saved 6 dollars
last month, at a cost of $1 today, rather than paying today for a
promise of saving $6 next month.
What is the duration
of your average contract and is there an early get-out penalty if I
am unhappy with your services?
The duration of the
standard contract is 1 year and one day to satisfy CMS guidelines.
However normally you may end the contract without cause and without
penalty by providing a 30 day prior written notice.
Do offshore
outsourcing services utilize the RadPayor?
Yes. However, expect to
pay less than 1/8th the normally quoted rates. The
“manager’s report” can be utilized as a substantial
negotiating tool to obtain very competitive contracts. Contact us for
referrals and references.
Can the RadPayor
handle large high volume groups?
Yes. The RadPayor
allows many coders to work within the same account simultaneously.
(as well as managers, physicians, etc). This allows a single large
100+ radiology group, capable of several million procedures per year,
to be easily handled by the RadPayor system. The RadPayor can
essentially handle an unlimited number of individual separate
radiology groups. An SQL enterprise database structure is utilized.
What do you mean
when you say; “Based upon your specific billing software; Expect to eliminate your “small balance write-offs.””
The RadCheck-In and
RadVerifier modules allow the calculation of “pt. owes,”
so any balance can be collected at the time services are delivered.
If this is not possible, the modules collect patients’ email
and txt messaging information, allowing patients to be notified
electronically of online payment options which are then auto-posted
when received. This allows the collection of “small balance
write-offs” to be performed entirely electronically and thus
economically. Yes, it can also be used to send out all statement
notices if you wish, thus almost eliminating your mailing costs while
offering your patient’s the convenience of online payments,
(improving collections and stopping the automatic loss of “small
balance write-off” revenue)
As an imaging center
do I need to worry about the ICD-10-PCS codes?
No. The ICD-10-PCS
codes are used on inpatient procedures only. Only rarely should you
get a referral that references the ICD-10-PCS if systems are
functioning correctly.
Our radiologists
perform needle biopsy procedures and over-reads on fluoroscopic
guided procedures performed by general surgeons at the hospital. Do I
need to worry about the ICD-10-PCS codes?
Yes. These procedures
will sometimes be performed on hospitalized “inpatients”
and would need to be dictated appropriately to allow coding in the
ICD-10-PCS format. The actual radiology report may contain either the
ICD-10-PCS or CPT coding or both. For you to file a claim for the
radiologist’s services however, you must use the CPT coding
format.
What are the
“unspecified codes”?
Certain codes in ICD-9
are termed “unspecified”. “Chest pain” (R079)
and “abdominal pain” (R109) are good examples of
“unspecified codes” that are used daily in substantiating
medical necessity. (payable diagnosis). Such codes are considered too
general and not very specific. Presently in ICD-9, the “unspecified”
codes can be used to substantiate medical necessity as there is no
blanket rule preventing their use. It is highly rumored that with the
implementation ICD-10, CMS will no longer allow the use of the
“unspecified” codes. Allowing the use of “unspecified”
codes would erode the primary benefit of the ICD-10 format, which is
much greater specificity. In ICD-10 coding, all of the “unspecified
codes” end in either a zero or nine. If CMS or others decided
not to allow “unspecified codes”, they will not pay on
those claims supported by the ICD-10 codes ending in a zero or nine.
*(the above discussions
are based on general radiology groups performing mostly diagnostic
studies. Coding a high percentage of interventional studies will
produce slower performance standards)
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