Background:
You are the senior supervisor at “Money is Important Hospital”. One of your primary responsibilities is to review the bi-weekly budget for the Computed Tomography (CT) Department.
For the recent billing cycle budget report, you notice a drastic change (increase) in your Relative Value Units (RVUs). As you know RVU’s are a measurement of productivity for a hospital. You also know that the RVU is the best way to associate the time a technologist or department spends on a particular exam. For example, you know that a CT of the chest is 1.0 RVU’s or approximately 1 hour of billable time. Therefore, if you make 1 RVU, you know you can spend 1 Full-Time Equivalent (FTE) hour (an FTE equals 40hrs a week) in labor (the techs, admin staff, etc) on that exam. If in a day, you make 20 RVU’s but spend 25 FTE Hrs you are over budget. If you make 20RVU’s but spend 19FTE Hrs you are within budget and so on.
For “Money is Important Hospital”, Your RVU’s are based on a variety of things but mostly what the Chief Finance Officer of the organization sets a particular exam based on reimbursement rates. Rates are typically attached to a Current Procedural Terminology (CPT) code (procedures) and the associated International Classification of Diseases (ICD-10) codes (diagnosis).
Your Investigation:
In researching the RVU increase for the CT department, you notice the number of exams mostly stayed the same with the annual exam averages report. You also notice that as your average, the majority of exams on the scanner are Head CTs and subsequently Abdomen/Pelvis exams.
Using your trusty reporting tools from the radiology information system (RIS), to data-mine the billing information, you find that the increase of RVU’s can be attributed to the abdomen/pelvis exams on the scanner. For some reason, your scanner is sending a message to the RIS to bill twice as much as the CPT standards allow. You have been over-billing your patients.
Some Technical Information:
Your CT scanner contains a list of exams that the technologist can select. These exams each have a CPT code attached to them that gets sent to the RIS for billing. The technologist can select the appropriate exam based on the order but the CPT code is in the background information and is not visible to the technologist on the screen.
There are three (to keep our case study simple, we won’t do with/without contrast) types of exams in the Abdomen/Pelvis on your billing reference list.
Abdomen/Pelvis 74176 – RVU 1.5
Abdomen 74150 – RVU 1.0
Pelvis 72192 – RVU 1.0
Assignment:
Using the information provided:
Describe why an imaging department uses FTE’s and RVU’s as the standard for budgeting.
Discuss what resources you might use to help find the problem in the case.
What do you think the problem and solution are?
