The radiology department is typically one of the biggest within a healthcare facility, and the Radiology Information System (RIS) is a critical component of this department. Facilities rely on these systems to manage imaging protocols by modality as well as charging for services and orderables. Therefore, if your RIS contains incorrect or outdated data, you can quickly run into patient care, reimbursement, or compliance issues.
Many facilities do not have the resources to dedicate a full-time employee to keep the RIS up to date. The task is often delegated to managers who are already working full-time managing their team or even IT staff who don’t have the background or expertise necessary to correctly determine which codes should be linked to which procedures. I’ve seen both of these situations in my work with clients.
So, what is a facility to do? At the very least, you need to make a comprehensive, end-to-end review of your RIS an annual occurrence. To help you get started, I’ve pulled together the reasons why an annual review is so important, what you should consider in a review, and what your end goals should be.
Why Conduct an Annual RIS
Your RIS is far from static. Between the potential for quarterly code updates as well as annual updates and adjustments such as new services or procedures, frequent changes are inevitable. Checking your RIS each year provides the opportunity to make sure all of these adjustments have been made properly and are working together as they should be. It also ensures that you catch any mistakes within the year so that you can make any claim corrections if needed.
This need for yearly review is highlighted well by a situation I saw where the RIS was incorrectly set up to only drop one code for any bilateral tests or procedures. It was a two-for-one special anytime the facility did a bilateral test or procedure! They weren’t doing annual RIS reviews, so they didn’t find this mistake for 3.5 years, and it likely cost them millions of dollars in reimbursement.
The moral of this story is to make sure you’re doing a thorough RIS review at least once a year.
What Should Your RIS Review Consider
When you’re conducting a review, it’s important to go into it knowing what to look for. So, when you dive into your annual RIS review, what do you need to consider? There’s a reason you shouldn’t be leaving this check to your IT department…
- Understand who is affected. You need to consider the doctors, the technologies, and the coding and billing staff. Are they provided the correct information required to do their job well?
- Make sure any updates are implemented correctly. As we’ve noted, your RIS should receive frequent updates, and it’s important to ensure they are all set up correctly. Have all affected modalities and orderables been updated as well?
- Check your descriptors. The descriptors within your RIS are what your technologists are relying on to ensure they’re selecting the correct exam. Don’t assume that because something has always been shortened to a specific phrase that it will be clear—you want everyone, from the 20-year veteran to the brand-new tech, to clearly understand what they’re selecting.
- Double-check reoccurring issues. Check-in with your coders to see if there are specific problems hitting their work queue that they see over and over again. Any repeat offenders may be an issue within the RIS setup itself—this means you could have claims making it through the scrubber with the same issue, setting you up for compliance issues.
The End Goal
Of course, the end goal of any RIS review is identifying and correcting issues to ensure you’re not creating any reimbursement or compliance problems. Here are several guiding principles as you pursue this goal to ensure a healthy RIS:
- Ensure your technologists know how your system works and what their protocols are. This means that your descriptors need to be clear to ensure they understand what procedures to select and are not selecting multiple services because they don’t realize one service is a component and therefore covered under another procedure they’ve already selected.
- Ensure the codes and descriptors are linked correctly. This helps you avoid incorrect billing—either over- or under-coding—and minimizes your compliance risk.
- Ensure your coders understand how the RIS works. If they understand how services are set up within the RIS, then they will understand when they need to escalate an issue so that it can be corrected within the RIS, instead of correcting it in the claim they’re working on and moving on to the next one.
A healthy RIS is a critical component of a healthcare facility. Make sure that yours is working the way it should be to avoid lost reimbursement and ensure you’re not creating compliance issues.
Written by Cathy Huyghe, CPC