Like radiology groups around the country, the 12-radiologist Kootenai Imaging in Coeur d'Alene, Idaho has been typical in its growing need for optimized billing management. With only two non-physicians on staff-the organization's practice administrator, Scott Venera, and one nurse practitioner, Kootenai Imaging is a lean medical organization, and until earlier this year, the practice had its billing and collections work done by a small, locally owned firm. “But we've essentially outgrown that model,” Venera says. “So we put the whole thing out to bid, and at the end of the day, we settled with McKesson”-the McKesson Revenue Management Services solution from the Alpharetta, Ga.-based McKesson Corp.

Today's reality for medical groups, Venera says, is that “You can't just send out a bill any longer and call it good.” Instead, he says, he and his colleagues came to realize that “We needed a better pulse on our financial practices, and the ability to data-mine, so that we would be better prepared for changes we're currently facing, and are about to face, including competitive pressures, reimbursement, the transition to ICD-10, and the PQRS pressures,” referring to the quality measures required under the Medicare program's Physician Quality Reporting System, which currently provides bonuses for meeting certain quality standards, but which will also involve reimbursement cuts in the next couple of years.

The solution went live on July 1, and at press time, Venera and his colleagues at Kootenai Imaging were just beginning to plumb the first metrics around improvements in efficiency and effectiveness of their billing system. But what is already clear, Venera says, is that the future in this area lies in the ability to apply data analytics to all aspects of billing and collections in the medical group setting. “Data is so important to analyze moving forward,” he emphasizes. “You really need to anticipate where you need to be; and if you don't have the ability to take the data that you generate and be able to show measurements of various types, you're not going to succeed.”

Healthcare Informatics 2011 November;28(11):13