Revenue Enhancement Projected Through New Policy
In response to the significant budgetary challenges BWH faces in the coming year, various efforts are underway to maximize reimbursement.
One such effort focuses on reducing payment denials issued by insurance carriers caused by non-compliance with radiology pre-authorization rules. Carriers require pre-authorizations for only a small fraction of the radiology studies (about 60 tests per month). Currently, Aetna, Cigna, GIC and several smaller PPO's require pre-authorizations for some non-emergency, outpatient radiology and nuclear cardiology tests performed here.
“Despite the low volume of affected tests, the revenue loss associated with foregoing the required pre-authorization is estimated at $500,000 per year,” said John Fernandez, vice president.
As a result, BWH has implemented a new policy (effective April 1) to schedule outpatient non-emergency radiology tests that require pre-authorizations only after the referring physician's office has obtained the pre-authorization number. The physician or staff must complete and submit the form.
“We recognize this is an additional requirement and thank you for your support,” said Allen Smith, MD, MS, chief medical officer, Brigham and Women's Physicians Organization (BWPO), who explained that other radiology facilities in the area have instituted comparable requirements.