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Radiology Volumes Are Different From What Finance Is Reporting. Why Does That Keep Happening?

By: Sahel Shwayhat, MBA, FACHE

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Telephone: 860-580-5177

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Many of us who have worked in hospitals have been there; you are in a meeting with Finance, and their handouts have what is supposed to be Radiology volumes, but they are different from what Radiology�s internal reports show. So, whose numbers are right?

Radiology is one of those areas where you can have different volumes for the same thing, and they can all be correct. I hope this article can explain what perhaps is being counted and help prepare you with the right questions to ask the next time you are presented with inconsistent data.

Consider the following:

One patient can have multiple outpatient exams over time. In this scenario, it is important to distinguish among counting unique patients, unique exams, and unique cases. case exam graphs

One patient can have multiple exams in one session. Although it is a single time slot, there may be multiple exams in the Radiology Information System (RIS) associated with that single patient. Again, there is a need to distinguish between counting patients and counting exams.

One exam can produce multiple CPT codes. Although exam codes are usually one-to-one with billing codes, there may be occasions where an exam can produce multiple billing codes. Again, what is being reported?

In a single case, you can have multiple exams from different modalities. A patient may have an x-ray and an MRI, or an Ultrasound and a CT. It is important to find out how the data are being reported. Is only one of them being counted, or is the case being duplicated and counted once in each column?

Now, just to add a little more confusion, beware that there are different terms used to describe the same things. Here are some:

  • A Case is sometimes called an Encounter. In the financial systems, charges and revenues, and direct and indirect costs are calculated and reported at the Encounter level. To avoid double counting revenues and costs, Finance may assign a case with multiple modality exams to only one modality based on some hierarchy (e.g., MRI trumps x-ray).
  • An Exam is sometimes called an Accession. In RIS each exam has a unique accession number. As a side note, for the purposes of "big data" analysis (my specialty!) accessions are extremely important when it comes to process/operations analyses since timestamps, exam codes, along with demographic information can be found at that level.
  • A CPT Code is sometimes called billing code, fee code, charge code, or simply "procedure". In my experience, the latter is what I have seen used most often.

Now, in case you are starting to feel confident that you understand everything above, allow me to introduce you to Nuclear Medicine!

If there is an area where the discrepancy among reported volumes is greatest, it is most likely Nuclear Medicine. The reason is, in one word, "injections".

In Nuclear Medicine, a patient is injected with a radio-pharmaceutical and then scanned. Sometimes, as in the case of a stress test, that process is done twice.

Injections take technologist time and are often scheduled in the RIS on a particular resource (i.e., room). Nuclear Medicine sections often choose to count injections as procedures, which helps explain why volume discrepancies can get big. In the case of a stress test, one case could be counted four times (2 injections + 2 scans) in Radiology�s internal reports.

How these procedures are counted also needs to be understood. Some Nuclear Medicine sections create a no-charge statistical fee codes for the purposes of counting injections, while other sections base their count on the number of times the injection room is utilized. Neither is wrong, as long as the counting process is consistent.

Finally, I will reiterate what I mentioned previously: all the volumes reported can be correct, they are simply counting different things.

Hopefully, this article helps explain the discrepancies, and helps you ask the right questions when presented with volumes (or asked to produce volume reports).

Sahel Shwayhat, MBA, FACHE, Principal at ELY Analytics, is a Management Consultant with over 30 years of experience in Healthcare Operations and Data Analytics. A Lean Six Sigma Black Belt, Mr. Shwayhat has dual degrees in Electrical and Biomedical Engineering. He is also is fellow in the American College of Healthcare Executives. Mr. Shwayhat's career spans multiple roles, where he gained significant experience analyzing large data sets to uncover inefficiencies, identify outliers, and compare staff and equipment outputs. He is adept at performing location analytics to identify potential clients, focus resources, and capture a greater share of the market.

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