ICD-10 coding will impact reimbursement for imaging, if you are not prepared. Detailed data for documenting the patient’s symptoms are required to be entered by the Referring Practitioners and if data is insufficient, claims may not be paid. Radiologists may have to contact the Referring Practitioners to obtain the missing information leading to re-work for both practices. Referring Practitioners may become frustrated if they experience more interruptions losing valuable clinic time and causing patient care delays.
Records must include accurate documentation of ICD-10-CM codes, CPT codes and ICD-10-PCS procedure codes in order to submit claims properly. Although the conversion to the ICD-10 code set is complex and vast, the advantages are important, including:
In 2013 Sage HMS patented a new technology for RadWise® CDS to support the new image ordering process for the complex ICD-10 codes. RadWise will meet the requirements of payers for documentation and may avoid prior authorization requirements altogether. These improvements due to RadWise’s simplified workflow reduce the frustration and interruptions for Referring Practitioners and reduce the denied claims for Radiologists that will in turn improve the patient experience and care. Overall, the specificity of the documentation will provide higher quality information for measuring healthcare quality, safety, and efficacy.
Staying current with evolving medical knowledge can be addressed with the application of intelligent, evidence-based guidelines. Physicians have said they need the benefit of relevant clinical information at the point of care. In addition, physicians demand easy-to-use, workflow-efficient solutions that enhance their own ability to deliver safe care. Until now, efficient delivery of evidence-based decision support has been problematic.
With the introduction of Internet technology, organizations have the opportunity to provide clinicians with the clinical knowledge and evidence-based support that they want and need.
Sage HMS applications help physicians/staff select appropriate diagnostic tests at the point of care, and direct the diagnostic specialist referral. Applications developed by Sage HMS:
Sage HMS makes its guidelines readily available to registered users who want to learn more about the literature underlying a recommendation. Because the body of knowledge in medicine grows exponentially, the embedded decision support criteria is continually updated. Real-time updates are incorporated so users and patients can immediately benefit from changes.
The application platform is browser-based, is designed to stand-alone or interface with existing information systems, and requires only Internet access with a user ID and password.
Perhaps most importantly for physicians and clinicians, the evidence used to develop the guideline criteria are transparent.
The following example is from a RadWise® case where the referring physician simply marked "cough." The system, based on medical evidence, explains that "cough" is not enough information to document the appropriateness for an imaging procedure. This Criteria page shows the various symptoms that are used to evaluate the proper procedure to diagnose abscess of the lung. In this example, the user added that a chest x-ray had been done with abnormal results. A provider can navigate to determine what procedure is recommended for a specific array of symptoms, or order a user-selected procedure with documentation. The criteria are transparent and the provider is in control, yet accountable and supported during the imaging procedure selection.
The handling of clinical information in RadWise is uniquely different from typical utilization review/prior authorization programs: