Tuesday, December 29, 2009

Make Your Medical Office Staff More Efficient in 2010!

It is the end of the year, many medical offices are looking back at what went wrong and looking forward to what can be better for the new year. Healthcare is in reform. Everyone is waiting to see what changes will come about and when. That includes prior authorization/pre-certification for advanced imaging. For now, it is business as usual for the health insurance companies. In order for your patient to get that MRI, CT, PET scan or nuclear medicine study, your medical office staff will still have to obtain prior authorization/pre-certification. Is it going to be easier than last year? No. I suspect it will be more difficult in the future. And it will probably be one of the areas health insurance companies, Medicaid and Medicare will use to cut corners to contain cost. It is all about the bottom line you know! Well, what about your bottom line? Medical offices also need to be profitable. As you look at your bottom line for the past year, think about what you can do better this next year. If you could give your staff 25-50% more time to do other tasks, would that not be of benefit to you? The one-of-a-kind training program that I offer can reduce cost, staff frustration and improve patient outcomes by teaching your staff how to perform prior authorization more efficiently and confidently. By purchasing the training program before year end, you are also eligible for the tax write off.(IRS section 162, check with your tax advisor). Contact me today to get started! http://www.rosewoodconsulting.biz/

Happy New Year!

Monday, December 21, 2009

The Senate Has Passed the Health Care Bill....

The health care bill has passed the senate. Now we await the final revision of the bill and votes from the house and senate before the president can sign it into law. Then, the real questions will need to be answered. How are the health insurance companies going to react? President Obama has already placed additional wording into the bill that health insurance companies will not be allowed to raise premiums prior to the bill being enacted. We all know the health insurance companies are going to do whatever it takes to save their bottom line. We do not know what that will be yet but I am sure we will all know in due time.

In the meantime, are you confident your staff is prepared to handle precertifications (prior authorizations) for advanced radiology procedures? Are you experiencing delays or denials from health insurance companies for your prior authorizations of MRI, CT, PET scan and nuclear medicine scans? I can train your staff to be better prepared for what many are saying is going to be an increase in precertification/prior authorization for advanced imaging by health insurance companies. Visit my website for more details.

Thursday, December 17, 2009

Healthcare Debate Continues!

What does this mean to you as a medical provider or medical office? It means that no one knows what the outcome will be for healthcare reform. In the meantime, it is business as usual for the health insurance companies. They are still requiring prior authorization (aka precertification) for radiological procedures(MRI, CT, PET scan, nuclear medicine studies). If you are still having problems with this process, contact us to start your training program today. Order by the end of the year and receive 45 days of follow-up consulting services instead of 30 days! Remember, this is also a great tax deduction for your medical office! (see IRS section 162 and your tax consultant for details)

Wednesday, December 9, 2009

Did you know?......

Did you know that a standard CT of the brain exposes the patient to an equivalent of 115 chest xrays? With radiation exposure errors in the recent headlines as noted in an article posted in the Wall Street Journal, More Patients Got Radiation Overdoses in CT Scans, it is the responsibility of the imaging facility to ensure the correct dose of radiation is being used. It is also the responsibility of the medical provider to weigh the risks of doing a CT vs an MRI or alternative study in the non-urgent setting.Check out the radiation equivalency chart link located on my website. It is a great tool to educate staff and medical providers as to the amount of radiation the patient is receiving.

Saturday, November 14, 2009

New blog series called: "Did you know?"

For the next few blogs I will address some of the most common issues related to advanced imaging and the preauthorization of such studies in a non-urgent setting.
Did you know that an MRI brain without contrast is the preferred study for the sole complaint of worsening headaches in a patient without any underlying medical history? For a patient with cancer or a known brain tumor, the preferred study would be an MRI brain with or with/without contrast. Of course, if an MRI is contraindicated, CT would be the preferred study.
Many medical providers choose CT because they think it is cheaper and will be easily approved by the insurance company/advanced imaging management company. MRI can actually be cheaper in the long run. Specifically, when a CT is done and it comes back negative. If the patient continues to have symptoms an MRI is ordered anyway. Most importantly, MRI is the preferred study for neural imaging. Dr. Robert B. Daroff said at the annual meeting of the American Headache Society, "sensitivity of an MRI scan far exceeds that of CT scans for all neurologic conditions, not just headache".
Medical providers should think twice about ordering a CT vs an MRI for nonurgent conditions. Not only can an MRI save money in the long run, it prevents radiation exposure and gives better results.

Saturday, November 7, 2009

I remember....

I remember at the end of the day when working with medical offices, talking with them on the phone and collecting clinical information for prior authorization, I would think to myself how I would love to be able to teach them what I know. Hearing the frustration and stress in their voices and their words, I wish I could show them where to look for information, how to read the doctor's note, what the labs mean, why ordering an MRI brain is better than ordering a CT scan for headaches. All this has now come true. I am teaching staff all of these things and more! Being a nurse, what a great way for me to help patients by teaching medical staff.
If you are feeling frustrated and stressed out with this process, contact me at http://www.rosewoodconsulting.biz/
There is no obligation and no high pressure sales pitch.

I expect to pass through life but once. If therefore, there be any kindness I can show, or any good thing I can do to any fellow being, let me do it now, and not defer or neglect it, as I shall not pass this way again. ~William Penn

Tuesday, November 3, 2009

Medical Office Staff Are Stressed Out!

Seems like everyone is so stressed out these days! Today medical office staff are overworked and tasked with new duties for which there is minimal training. I know, I have been there, working in many medical offices over the past 10 years. On the job training was the rule, not the exception. And for the past 5 years as a nurse reviewer for one of the largest advanced imaging management companies, I have heard from many medical office staff how stressful their days have become. Coordinating care with patients, doctors, insurance companies and other medical facilities all at one time can be extremely stressful. The University of Pittsburgh Medical Center writes,"studies show that stressful working conditions are actually associated with increased absenteeism, tardiness, and turnover--all of which have a negative effect on the bottom line." This is a serious problem. One of the ways stress can be reduced with the prior authorization process(aka predetermination) is by having proper training. Stop the stress and frustration associated with this process by viewing my website to see how I can help.

Tuesday, October 27, 2009

Survey of Medical Offices in Process

I am currently performing a survey in different cities around the country. Some of the questions being asked of medical offices will include their biggest challenges with preauthorization for advanced imaging. For example, how much time is spent doing prior authorizations and the type of training staff have received. It will be interesting to find out how wide spread the problem is and their opinion about how prior authorization will be affected if the public option is passed. Results will be posted to my website and blog. If you would like to participate in the survey, contact me via email at: consulting@rosewoodconsulting.vpweb.com
Thank you for all your support! Terri

Wednesday, October 21, 2009

Commonly Asked Question: How Did I Get This Idea for Prior Authorization Training?

I frequently am asked how this idea for training of prior authorization for advanced imaging(MRI, CT, PET and nuclear medicine) came about. Years ago when I first started working for one of the largest advanced imaging management companies, I spoke with medical offices everyday. One out of three offices providing clinical were not able to answer the questions I was asking to approve the study. In that case, the study immediately gets sent for medical review. It becomes frustrating for both nurse reviewer and the staff member providing clinical. There is no formal training for medical offices. Some medical offices said they had never done a prior authorization before. Talk about on the job training!
After being on the job for about six months, I began to think about how medical staff could be trained and how that would make the process easier for both sides. That is where the idea began. Years went by and it seemed like nothing changed. Many of the medical office's staff members were still confused and unable to provide adequate clinical. Many reasons for this are outlined in my article, Prior Authorization for Advanced Imaging, A Nurse Reviewer's Perspective. It was two years ago that I started writing the article. I began to think about all the common mistakes and errors that led to requested studies being delayed or denied. Now, after many years of compiling this information and writing my article, I have created an affordable and easy training program to help medical staff or anyone who does prior authorization for advanced imaging to be able to give a clear picture to the nurse reviewer, answer questions easily and avoid the red tape associated with this process. You will find that studies will be easier to precert and that stress/frustration will be eliminated. Feel free to post a comment or start a discussion about issues you have had with the prior authorization process.

Thursday, October 15, 2009

Free Consultation, No Obligation!

Contact me today for a free consultation with no obligation! Learn how your staff can be better trained to perform prior authorization for advanced imaging(MRI, CT, PET scan, nuclear medicine). Become a pro at providing a clear clinical picture to the nurse reviewer, decrease delay/denials, eliminate stress and frustration with the prior authorization process. My teleconference training is easy, affordable and will benefit your staff for years to come.
visit my website at http://www.rosewoodconsulting.biz/
or email me at consulting@rosewoodconsulting.vpweb.com

Monday, October 5, 2009

Another Reason Precertification Training for MRI, CT, PET, Nuclear Medicine studies is Important

As the healthcare reform debate continues, there is business as usual with primary insurance companies. They are still requiring precertification for advanced imaging studies. And staff are still struggling with the process.
Contact me today to discuss how my affordable and easy training program can teach you how to perform this task. It will make prior authorization easier and reduce staff frustration. Whatever happens with healthcare reform, you will be prepared. If the bill passes or not, insurance companies will still require prior authorization for advanced imaging. And if the bill does pass, insurance companies will be looking for ways to tighten their belt to compete with a governmental program, making prior authorization even more widespread. Having the proper training will allow you to meet the demands of obtaining precertification and give you peace of mind whatever may come.

Monday, September 28, 2009

Why is training for prior authorization of advanced radiology imaging important?

Most non-medical staff designated to do prior authorization for advanced radiology(MRI, CT, PET scan, nuclear medicine) are not trained. Due to staff shortages and administrative cost cuts, non-medical staff are tasked with performing prior authorizations. An internist, Dr. Hoffman from Oregan, in a recent article posted in the American Medical News, stated, "a recent Health Affairs article put the problem into perspective with a report that each U.S. physician spends, on average, $70,000 each year resolving insurance-related issues". Specifically, the prior authorization process can be confusing, especially for non-medical staff. Providing incorrect clinical information, the lack of clinical information and incorrect CPT codes, just to name a few of the many errors I have witnessed with medical office staff as a former nurse reviewer, can easily lead to delays and denials.

Wednesday, September 23, 2009

What does the future hold for prior authorization of advanced imaging?

In the ongoing debate about the public healthcare option and President Obama's proposed plan, there remains the question of what will happen with prior authorization.
From the many articles recently released, it does not appear that it will go away anytime soon. An article from Mass Device, written by E. Berger, Aug 2009, states "The healthcare reform legislation working its way through the Congress seems likely to include a proposal to establish (for Medicare or any publicly managed program) Radiology Benefit Managers(RBMs) organizations which would review and approve the appropriateness of referrals for advanced imaging". Another article, RBMs Are Part of Obama Plan from Radiology Today also describes how prior authorization for advanced imaging may be included. This initiative, if passed with the healthcare bill, will make prior authorization for advanced imaging(MRI, CT, PET scan, nuclear medicine) even  more of an issue for medical offices.

Monday, September 21, 2009

Welcome to Training for Prior Authorization of Advanced Imaging

Welcome to my blog! My name is Theresa Richards. I am a nurse consultant for Rosewood Consulting, a company I created to train staff how to perform prior authorization for advanced imaging (MRI, CT, PET scan, nuclear medicine).This blog was designed to provide information and tools for prior authorization of advanced imaging.