BLOG: Improving Productivity and Simplifying Patient Eligibility for Imaging Practices

Integrations add more productivity to the patient and provider experience.

The eligibility and liability landscape for imaging practices can be complex and confusing for patients and providers. New automation integrations into the imaging workflow help streamline insurance-related tasks by verifying patient exam eligibility, identifying patient liability at the time of service, improving planning and respecting the next CDSM mandate for appropriate use criteria.

“When we look at what you can do with software to improve imaging center productivity, we want to reduce the time it takes to complete any task,” said Kevin Borden, vice president of product, HCIT, for Konica Minolta Healthcare Americas. “Specifically, we’re looking at ways to add end-user automation so the software becomes more efficient.”

Verification of patient eligibility and estimation for imaging procedures

Konica Minolta Exa Platform now includes a fully automated, real-time billing and medical insurance quote processing solution that verifies patient eligibility for imaging procedures. The Exa platform is an integrated RIS, PACS and billing solution. Through a partnership with ImagineSoftware, Exa RIS users can seamlessly verify patient eligibility for an imaging procedure and provide the patient with an out-of-pocket estimate when scheduling an appointment for a flow. more efficient work. Konica Minolta chose ImagineSoftware because of the company’s high success rate with automated eligibility support and insurance payments.

“Eligibility is all about precision and timing. You want to get the most accurate results as quickly as possible,” Borden said. “In combination with eligibility, the patient estimate helps the patient understand what payment is due for their appointment without surprises.”

The recent establishment law without surprise now protects patients against surprise medical bills resulting from gaps in insurance coverage for out-of-network clinicians at in-network facilities. The law removes consumers from litigation and allows a resolution process for providers and health plans. For many practices, confirming insurance eligibility and estimating payments before or at the time of service helps ensure coverage, reduce eligibility denials, increase reimbursement payments, and Obtain co-payment from patients.

The Appropriate Use Criteria solution integrated into the Exa platform.

Support CDSM mandate for appropriate use

From 2023, Medicaid and Medicare Service Centers (CMS) will mandate the use of a Clinical Decision Support Mechanism (CDSM), a tool that communicates Proper Use Criteria (AUC) for advanced diagnostic imaging to help make appropriate treatment decisions for a patient’s specific clinical condition.

“CDSM will become mandatory in January 2023, and we’re giving customers the benefit of being ahead of the mandate,” Borden said. “We can begin implementation and training now, so that once the mandate is in place, providers can continue to order exams appropriately without any hitches or drop in volume.”

To fulfill this mandate, Konica Minolta has partnered with LogicNets to integrate its LogicNets AUC solution into the Exa platform. Orders placed through the Exa Physician portal will be automatically validated electronically with the LogicNets solution.

Increase efficiency with automated scheduling

Similar to how the Exa platform can now leverage automation to improve the patient eligibility and accountability process, Exa can also automate scheduling capabilities, to help bring additional efficiency and optimization on the calendar of an imaging centre.

“Things that happen manually today can now be automated, so instead of doing tasks one at a time, you do that task 10 at a time or 100 at a time,” Borden said. “Whether it’s offering a patient an earlier exam time or changing the schedule to minimize openings, we can now use automation rather than someone having to physically pick up the phone and call the patient.”

Editor’s note: This blog is the second in a two-part series on leveraging innovative technologies to improve clinical productivity. The first blog, Integrating Speech Recognition into Radiology Platforms to Improve Workflows and Patient Care, is available here.

Related Content: Talking Trends with Konica Minolta: Improving Productivity with Automation


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