Laura Casey

Radiology information system (RIS) management reporting data creates a wealth of opportunity for physician practice organizations to enhance revenue. RIS information offers clues to the organization for marketing and patient access optimization, auditing tools to ensure that accurate and comprehensive billing takes place, and a safety net for accurate recording of physician relative value unit (RVU) production.

Freestanding reports such as Time Flow Study, Referral Tracking, Referring Physician Patient Examination, and Canceled Examination contribute to the basics of trend analysis. However, combining the data from several reporting sources can yield mindful, well-rounded data and invaluable trends for a marketing team. This article reviews the basic reports and includes some suggestions for creating customized reports that will present additional views of the data.

A Time Flow Study Report is an event log that breaks processes down for a specific period of time. The report seeks to identify and validate peaks and valleys across processes such as scheduling, examination begin and completion, transcription, preliminary reports, and signed final reports. A Time Flow Study Report used at a high level over a long period will unearth opportunity for process improvement, leading to optimized schedules and referral sources that are content with service.

A Physician Referral Report counts, for a given period of time, the number of patients and examinations referred, total number of individual patients referred, total number of examinations referred, total hospital revenue generated, and total professional revenue generated by a referral source.

A Referring Physician Patient Examination Report lists the types of examinations ordered by referring physicians. This report is an invaluable drill-down tool for referral patterns. This report can be used to find patterns of referrals by modality and by location. Does a referral source send patients who need MRIs to your practice but not CT?

A Canceled Examination Report selects canceled examinations for a specific time frame and lists them in order of department and chronology. Use this report to identify where examination resources are available because of cancellations. Trending why, when, and who is cancelling examinations may help reduce the number of cancellations. It is also a helpful tool in identifying and addressing barriers to access or other service issues.

Cross-Checking Data

In combining the data of the above-mentioned four reports, many questions can be posed and many possible answers suggested. For example, a Time Flow Study Report run with 12 months of data may indicate a possible access problem to a particular modality. It may be very likely that the referral source identified the problem before the practice noticed and redirected patients elsewhere. An extended Time Flow Study Report will shed light on such a trend. Once the access issue is resolved, the Referring Physician Patient Examination list will clearly indicate which referral sources are in need of attention from the marketing team.

Look also for a correlation between the Canceled Examination Report and the Physician Referral Report. Was an increase in cancellations followed by a decrease in referrals, and can the Time Flow Study Report offer data that points to a service problem? Did the time between examination complete and final report rise dramatically?

A key to enhancing incoming revenue lies in the thoughtful dissection of RIS data. Groups should begin using standard RIS management reports but also expect to evolve those reports to fit the strategy, process, and needs of the group. Consequently, the organization should plan for an internal reporting writing resource.

Data Auditing and Billing

The architecture of the RIS and that of most billing software is fundamentally different. The RIS is an examination-centered structure seeking optimization for scheduling and examination functions. Most billing software is transaction-oriented, and therefore it is paramount to audit the two systems to ensure that all billing-oriented data captured by the RIS is captured in the billing system as well.

Each morning the RIS should generate an Examination Summary sorted by site and/or modality. This report represents the completed examinations and all billable items from the prior day and is audited by the technologist and acknowledged as complete and accurate based on the prior day logs. Asking staff to validate its work from the previous day will uncover billable items such as contrast material and medications that may have been added to the examination while in progress, but not entered into the RIS.

The Completed Examination Report can be used to compare the data in the billing system with the examination data in the RIS. If the reports do not sync, then run other reports to find the examinations in the RIS that have not been billed. Report on all holding areas or queues (ie, signature queues, coding queues, billing exception queues), and require staff and physicians to act on examinations halted in the process within a specified time period to ensure timely filing deadlines are not missed.

Know all points in the RIS where examination billing can be halted, and report on all related criteria, such as monthly tracking of cancellations and no-shows. Review all "no charge" functionality weekly and be certain for RVU (relative value unit) capture that no-charge examinations are passed to the billing system. Report and trend no-charge examinations and the reasons for the nonbillable item(s).

In some cases, the reports mentioned here will need to be created. The daily audit function between the RIS and billing software is a necessity to ensure that complete and timely charge capture and billing occur. With this process-oriented reporting, groups will minimize filing denials and capture billable items added to the examination during the patient's visit.

Other RIS report considerations are a Missing Preauthorization Report, Payment Reconciliation Report, and No-show Report. Run daily, the Missing  Preauthorization Report finds patients who are scheduled and require payor authorization but for whom no authorization has been obtained. If a practice is entering payment information into the RIS, a Payment Reconciliation Report is necessary to deter theft and ensure all funds are accounted for on a daily basis. The No-show Report traditionally is used to possibly terminate patients from the practice. However, no-shows trended by referral source may uncover troubled referral sources and the practice may elect to address the source directly.

Marketing strategy and billing audits are clearly enhanced by effective use of RIS management reporting. And leveraging such data will assist organizations to tap into newfound revenue streams.

Laura L. Casey is director of Austin Radiology Associates, a 59-physician radiology practice based in Austin, Tex.