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No one would knowingly invest in a business whose principal executives knew little or nothing about the key components determining reimbursement for the services provided. Superimpose on that lack of knowledge a regulatory environment in that business sector that places owners and key employees at risk for accusations of fraud and abuse as well as in jeopardy of large fines and potential exclusion from the marketplace for the largest consumer of a company's product if billing is done incorrectly. Yet this is exactly the case in many radiology practices today. A significant number of radiologists who provide excellent quality medical care produce dictated reports that demonstrate complete ignorance of the parameters used by their billing personnel to generate accurately coded claims, thus losing significant legitimate clinical practice revenues while placing themselves and their practices in jeopardy. This article does not outline ways to game the system or inappropriately augment practice revenues. Rather, it describes many of the basic elements needed in the dictated reports produced by radiologists in their daily work, calculates examples of the financial impact of medically correct but poorly documented reports, and provides dictation guidelines for radiology residents and radiologists in practice that, if adopted, should ensure that you get paid properly for what you do.

Noninvasive vascular testing grew from a need for a safe, accurate, and inexpensive alternative to contrast injection venography and arteriography. The ultrasound studies performed to evaluate vascular disease today meet all expectations for safety and accuracy, and cost thousands of dollars less than their contrast counterparts, yet few sectors in medicine have been challenged so regularly by the Health Care Financing Administration (HCFA). Tests performed on duplex ultrasound instruments have prevented innumerable arterial and venous injuries and episodes of renal failure caused by contrast injection. Despite those laudable accomplishments, the financing agencies continue to reduce payments, threaten inappropriate supervisory requirements, and belittle the overall importance of the examinations. This report reviews the last decade of payment issues involving the vascular laboratory, pointing out inequities and problems that threaten not the quantity, but the quality, of this technology. The discussion focuses on Medicare Part B payments because they represent the majority of payments for noninvasive studies across the United States. The topics include payment denials, supervision issues, and problems associated with the zero work pool. In addition, the method by which HCFA calculates relative value unit (RVU) payments for procedures is included., (Copyright 2001 by W.B. Saunders Company)

Preliminary Studies: Data on obstetric complications are the basis of monitoring maternal mortality interventions in the PMM Network. A review of recordkeeping procedures at 10 facilities in the study area revealed that information on obstetric complications was often inconsistent or missing. Some hospital records were not designed to collect such information at all., Interventions: In 1992, registers at facilities were revised to collect information on complications and time of treatment. Doctors, nurses, midwives and clerks were trained to record, compile and analyze data. Monitoring and supervisory mechanisms were also set up., Results: Recordkeeping has improved. Data collection and analysis have been regular and timely. Doctors have begun using the data for morning meetings. Nurses and midwives compile monthly summaries of data showing complications by type. Two other districts outside the research area have adopted the reporting system and it is possible that facilities in the whole region will follow suit., Costs: The cost of improving recordkeeping at the 10 healthcare facilities was approximately US $2543, with 85% coming from project funds., Conclusions: Existing recordkeeping systems can be modified to collect data necessary to monitor maternal mortality interventions. Staff training and monitoring visits are important to success.