Radiology Business : Radiologist shares tips on getting paid—well—for all your reads
Jessica Kania | Experience Stories
The radiologists at San Luis Diagnostic Center, a multimodality outpatient facility in California, are happy to do it all: mammography, CT scans, ultrasound, X-rays, MRI, and more. There’s one aspect of their radiology practice that they’re excited to hand off, however: billing and negotiations with third-party payers. Especially now that they’re sure they’re getting paid for all of their exams and interpretations, and at a market rate.
Back in 2018, the practice found that as an independent billing entity, they had almost zero negotiating power—so they decided to merge with other local practices that had already taken the steps to become California Managed Imaging (CMI), a larger entity that allows each of the practices to retain their independence while also giving them a better chance to negotiate better rates for their work as a group. This arrangement was favorable to both the radiology group as well as the third-party payers. It allowed the third-party payers to deal with only one contract for services over a large geographical area and for the radiologists to get a more favorable market rate in return.
An independent billing manager managed the finances for the group until about a year and a half ago, says Fred S. Vernacchia, MD, a board-certified radiologist and the medical director for San Luis Diagnostic Center, and a long-time reviewer for the American College of Radiology’s practice guidelines. That’s when CMI heard about another option to help take care of the business side of things: Collaborative Imaging.
“Collaborative Imaging made a commitment based upon our current collections that they could do a better job—and they did. My review of YTD data shows that exam count, as measured in our PACS system, is up 8% whereas our cash collections have increased by 21%, all else being constant.”
— Fred S. Vernacchia, MD, Medical Director, San Luis Diagnostic Center
Not only would Collaborative Imaging manage their billing, but they’d also provide management services, including negotiations with third-party payers on the group’s behalf—all while offering their assurances that they could improve collections numbers, thanks to proprietary, state-of-the-art technology tools.
“Collaborative Imaging made a commitment based upon our current collections that they could do a better job—and they did,” Vernacchia says. “My review of YTD data shows that exam count, as measured in our PACS, is up 8% whereas our cash collections have increased by 21%, all else being constant.”
Since making the switch, here’s how working with Collaborative Imaging has enabled San Luis Diagnostic Center to increase revenue while improving customer service, from the moment an exam is ordered to the time the last payment is retrieved.
Early collection of copays shortens the payment cycle
Billing efficiency starts even before a patient steps foot into the office for an exam. In the background, Ci software can calculate a patient’s precise copay, even adjusting the amount as necessary based on whether a patient has satisfied their insurance deductible. Patients receive a text message telling them what their commitment will be, and the imaging center staff knows what to collect when the patient arrives.
With a few taps, they can even pay their bill before they arrive for their exam. Of course, not all patients are so diligent—but when patients don’t pay, Ci will track that and issue regular reminder text messages. That leads to fewer calls to patients asking for payment by the imaging groups, and better relationships with patients.
For sure the practice has seen shorter collection cycles, Vernacchia says. Those who prefer written statements can still receive them, but many patients—even seniors, he notes—are happy to pay with their credit card online and cross the payment off of their “to-do” lists early.
“The text messaging works remarkably well with patients, of all ages,” he says. “Most of the time, I’m going to get their copay right upfront.”
He knows that well, because he keeps a close eye on the numbers. Every Monday, Vernacchia reviews a spreadsheet that shows how many text messages Ci sent to their patients, how many people required printed statements, and how many payments are outstanding for over 90 days. Additionally, he can always review a billing dashboard to access more information at an incredible level of detail.
“I can see our total amount of RVUs that we’ve generated, how much has been billed, when it was billed,” he says. “I can see RVUs generated by date of service, RVUs by billing date. The data is endless and truly helps us get paid in a very timely manner. And it helps us provide good service to our patients.”
Advanced auditing services lead to 100% collection rates
Another major benefit to come out of the partnership with Collaborative Imaging, Vernacchia notes, is advanced auditing services. Before their partnership with Ci, he estimates that his practice missed a small number of exams every month, on the order of five to 10 random exams. That’s because sometimes the case information didn’t make it all the way from the PACS to the hospital’s electronic feed and then to their auditing company.
“Our previous auditing system was doing a pretty good job of making sure that what made it to the auditing system was getting billed and paid, but they completely ignored the fact that sometimes, what was coming out of our PACS wasn’t making it to them,” he explains. “We were performing the work, but the payers just never got billed.”
That left significant revenue on the table—and was another opportunity for Ci to jump in and course-correct. Now, Vernacchia says, the system is much smoother—and he is confident that 100% of the work they complete is getting billed, thanks to the fact that Ci’s system gets the information directly from the practice’s PACS.
“Each accession number from our PACS is matched with the accession numbers of what got billed,” he explains. “We basically send them a monthly feed, and they can look through that feed and make sure that every accession number that we had that we generated a report for gets billed.”
Reviewing contracts with third-party payers and your cost structure = top line revenue.
There’s yet another very valuable final piece San Luis Diagnostic Center benefits from in partnering with Ci. That goes back to the issue that motivated California Managed Imaging to band together as a group in the first place: a better bargaining position with third-party payers.
“Unfortunately, doctors have come to believe that if they’re busy, they’re making money—and it just isn’t true,” he says. “And so I think that Collaborative Imaging is beginning to get physicians to recognize the fact that just running patients through your scanners on a Saturday when considering your overtime staffing costs, after-hours imaging may not necessarily be economically viable.”
Additionally, Vernacchia says, their partnership with Ci means that third-party payers are more likely to pick up the phone and figure out payment after being given a 90-day notice—as they want to stay in the good graces of the many affiliated practices, so that they don’t risk losing an entire network. This is especially important in California, where insurers are required to maintain an “adequate network.”
A ‘special relationship’ with a radiologist’s touch is mutually beneficial
“If I had to ever describe a billing company that is more than a billing company and is your partner, it is Collaborative Imaging; they are genuinely interested in your success.”
— Fred S. Vernacchia, MD, Medical Director, San Luis Diagnostic Center
Yet another benefit that Vernacchia sees in working with Collaborative Imaging is that as a radiologist-owned company, Ci supports working together and looking out for other radiologists. While more intangible than other advantages, he says he believes that it is an important part of establishing trust and confidence in a billing company, and that it ensures that all parties’ interests are aligned. As a result of being radiologist-owned, Ci’s services take into account the needs of the very people they are billing for. 
“The owners of Collaborative Imaging are making sure that their company is working for the best interests of the owners, but the owners are also radiologists—so their other radiologist customers are benefitting from that relationship,” he says. “Whatever systems they develop to improve the workflow, efficiencies, and revenue of one practice can be rolled out to all of Ci’s clients.”
That special relationship between radiologists has carried over into a warm working relationship where Vernacchia says he feels like Ci is always in his corner, no matter what comes up.
“Even though Dhruv [Chopra] is the CEO of that company, and I’m by no means one of their bigger clients, I can send him an email with a problem and he’s back to me within 10 minutes,” he says. “I mean it.”
Even in instances where Vernacchia didn’t necessarily expect any help from Collaborative Imaging, he has found them to be proactive in their willingness to step in wherever they can lend a hand. For example, when San Luis Diagnostic Center was recently recruiting new radiologists and wondering how to alert more applicants to that fact, Collaborative Imaging put together a website for them—at no charge.
“So now we have a website. We have an internet presence,” Vernacchia says. “Potential recuits know how to find us. They didn’t charge us a dime. If I had to ever describe a billing company that is more than a billing company and is your partner, it is Collaborative Imaging; they are genuinely interested in your success.”