While equipping your facility with the latest technology to ensure your patients get the best care possible is the goal, budget is always a major aspect of the conversation. Ensuring that you get the best return on your investment will help ease those concerns. It is critical to build a business case that helps with the ROI argument, so understanding the financial impacts of your current situation will simplify much of the business case. Data standardization is an underlying cost that is impacting your financial situation, and many facilities fail to recognize this. Understanding how AI can help to improve your revenue cycle, reclaim dollars from missed billing codes, or realize product ROI are crucial.
Get Paid For What You Do
The revenue cycle of a healthcare system relies a lot on the expectation of getting reimbursed for services in radiology. Preauthorization starts this billing cycle. Each procedure must be approved in advance before the tests are completed to ensure the facility gets reimbursed. For example, a Head CT with and without contrast needs to be approved. Just submitting Head CT and not including the contrast may increase denial rates. Once approved and the study is complete, codes are confirmed, and the billing can go out. Easy enough, right? Well, not really… The amount getting billed is only as good as the codes, and just because something was preauthorized, doesn’t mean it will be performed or billed. The patient was preapproved for a Head CT with and without contrast but during coding the study was labelled as a routine Head – no contrast. This is where standardizing your data and having computer vision to identify that contrast was used on the study helps with reimbursement. Enlitic’s ENDEX™ recognizes the type of study, identifies the presence of contrast, and creates a standardized nomenclature for the study so that it is easily identifiable as a Head CT with and without contrast. This saves billing administration time and headaches when confirming that the study performed, and the study submitted for reimbursement matches.
Account For Changes That May Occur
The second way healthcare financials are impacted by non-standardized data is that there is a lot of missing revenue due to incorrect billing codes. This issue correlates well with the same example we have been discussing. A routine Head CT is ordered and preapproved, but during the scan it is decided to use contrast. If the technologist doesn’t correct the billing code in the system, the facility misses out on potential reimbursement, or the charge is denied. The incomplete documentation of the actual performed procedure and report decreases the collection amount by about 25%. AI, specifically the use of ENDEX, makes those incomplete codes, complete. By recognizing the presence of contrast and labeling studies as such, coders can quickly correlate the use of contrast in an exam and ensure the proper codes are billed. With the changes in details and number of CPT codes getting used, revenue numbers are being impacted by inaccurate billing and denials. Capturing 25% of missing revenues with the assistance of computer vision ensuring accurate labels generates the ROI needed to deploy an AI solution.
Utilize the Right Tools
That brings us to the final way your facility is negatively impacted by not having the proper tools and technology in place. Finding the right tools to better patient care and the workflows throughout your healthcare organization while saving money is tough. Software solutions like ENDEX can help reduce revenue cycle management and improve billing and reimbursement rates by simply applying data standardization. ENDEX provides standardized metadata descriptions of diagnostic medical images (DICOM). It uses proprietary natural language processing (NLP) and computer vision (CV) algorithms to analyze DICOM images and metadata to identify key attributes that characterize distinct types of radiological studies and series. Standardized metadata descriptions are added directly to the DICOM metadata to enable automated processing and analysis by downstream software. You can calculate the impact on your radiologists alone, by using the ENDEX ROI calculator to visualize the ROI from Enlitic.
ENDEX improves the reporting experience for the radiologist while generating strong ROI for the business, and improving patient care by getting them quicker, more accurate results.
Hospitals and other healthcare organizations have many challenges when it comes to creating the highest quality facilities, but when it comes to your financials, staff workflows and great patient care, it is crucial to have the right technologies in place. AI-based software that standardizes the data first should be the first place you look for a solution.
