I was recently asked if I thought 'middlemen' like CareCore National will go away? And the answer is "no".
The reason for this is simple. Medicare and Medicaid costs are putting great strains on state and federal budgets. Health insurance companies are making smaller profits now because of health care reform. Costs have to be contained somewhere. Advanced imaging is expensive. If you look at the health care cost pie, advanced imaging is the second highest expense behind prescription drugs.
In 2009, Med Solutions stated 90% of health insurance companies use RBMs. They also stated, "Radiology Benefit Management Could Save Medicare Up To $18 Billion Over 10 Years". Like most RBMs, they proclaim their management of advanced imaging saves money. With RBMs already in place and saving money, it is highly unlikely they will go away. Add to the fact that Medicaid/Medicare costs is a highly charged political and economical issue, it is even more doubtful RBMs will go away.
Yes, I believe RBMs save money for the actual imaging. But who pays the price? For one, medical offices, hospitals and radiology centers burden the cost of hiring staff to sort through the red tape in getting a study or procedure approved and following through until it gets paid. Second, the patient may have their study or procedure delayed or denied because of the red tape.
It can be frustrating, as the process for obtaining prior authorization (precertification) for advanced imaging is not transparent. Most office staff learn the prior authorization process as they go along. No one is teaching them, especially not the RBMs. And that can be costly to your bottom line and the patient.
If you would like a free consultation on how I can teach you or your staff to become more efficient at prior authorization for advanced imaging, email me at: firstname.lastname@example.org. I would love to talk with you! Terri