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Improving clinical histories on radiology requisitions
R B Gunderman1, M D Phillips, M D Cohen
1Department of Radiology, Indiana University, Indianapolis 46202, USA.
Insights
Billing for radiologic exams requires appropriate indications per Health Care Financing Administration (HCFA) regulations. A simple intervention significantly improved compliance but required ongoing reinforcement to maintain effectiveness.
Area of Science:
- Radiology
- Healthcare Compliance
- Medical Billing
Background:
- Health Care Financing Administration (HCFA) mandates specific documentation for radiologic examinations.
- Non-compliance with HCFA regulations poses legal and financial risks for both referring physicians and radiologists.
- Accurate indications are crucial for appropriate billing and medical necessity of radiologic studies.
Purpose of the Study:
- To assess the prevalence of incomplete requisitions lacking current diagnoses or appropriate indications.
- To evaluate the efficacy of a targeted intervention aimed at improving adherence to HCFA documentation requirements.
- To determine the long-term impact of the intervention on compliance rates.
Main Methods:
- A baseline assessment of 150 chest radiography requisitions was conducted.
- An intervention involving physician education and a temporary enforcement period was implemented.
- Post-intervention assessments included immediate follow-up and a 3-month follow-up to gauge sustained compliance.
Main Results:
- The intervention led to a significant decrease in missing diagnoses (69%) and indications (61%) (P = .001).
- Compliance rates decayed over time, with only 35% and 18% sustained improvement for diagnoses and indications, respectively, after 3 months without reinforcement.
- The findings highlight the transient nature of improvements without continuous reinforcement.
Conclusions:
- A straightforward intervention can effectively improve compliance with HCFA documentation rules for radiologic requisitions.
- Sustained adherence to regulations requires ongoing reinforcement strategies.
- The study underscores the importance of continuous quality improvement in medical billing and documentation practices.
Purpose:
The Health Care Financing Administration (HCFA) regards billing for radiologic examinations without an appropriate indication as unlawful, and both the referring physician and the radiologist are liable. HCFA regulations are interpreted as requiring that all requisitions for radiologic examinations include a current diagnosis and appropriate indication for the study. The purpose of this investigation was to determine the rates at which requisitions currently meet these criteria and to assess the effectiveness of a simple intervention designed to improve them.
Materials And Methods:
One hundred fifty consecutive chest radiography requisitions were examined to determine the rate at which current diagnoses and appropriate indications were present. An intervention was then implemented that included a month-long effort to inform referring physicians and radiologists of HCFA regulations, followed by a 1-week period during which requested examinations were not performed unless accompanied by a clinical diagnosis and appropriate indication. Another 150 consecutive chest radiography requisitions were then assessed to determine the effect of the intervention. A 3-month follow-up sample of a third set of 150 consecutive requisitions was then obtained.
Results:
The intervention produced a 69% decrease in the rate at which current diagnoses were missing from requisitions, and a 61% decrease in the corresponding rate for appropriate indications. Both results are significant with chi2 analysis at the P = .001 level. After 3 months with no additional intervention, rates decayed back toward baseline, with only a 35% remaining decrease for current diagnosis and an 18% decrease for appropriate indication.
Conclusion:
The intervention performed in this study significantly reduces the rate of noncompliance with HCFA regulations. However, this improvement decays over time if it is not reinforced.
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