Simple ED workflow fix improves history, billing in CT orders

Too often, providing quality clinical histories of imaging orders falls by the wayside, resulting in missed diagnosis, billing delays and payment miscommunication. But a recent study finds a simple intervention may right these poor habits.

Attending neuroradiologists from the University of Chicago published findings online Jan. 17 in the American Journal of Roentgenology. The team analyzed 1,100 ED requisitions for unenhanced head CT, assigning a grade to each for clinical and billing adequacy using a scale of zero to two.

Prior to the intervention, 400 studies were looked at by researchers, resulting in a mean clinical score of 1.32 and mean billing score of 1.64.

An intervention, in the form of a reminder slide projected on a large screen in the ED staff area, showed appropriate clinical history examples for the remaining 700 CT scans. Those requisitions were evaluated after the intervention with mean clinical scores rising to 1.43 for clinical history and 1.64 for billing.

“Our fairly simple intervention in the ED was successful in improving the overall quality of histories on CT head requisitions originating from an academic ED,” wrote Saad Ali with the department of radiology at the University of Chicago Medical Center, and colleagues. “The quality of histories improved for both clinical and billing adequacy parameters, and the percentages of studies receiving a score of 2 (good history) improved in both categories.”

The team also concluded reimbursement dollars did not increase or decrease, but the time between services rendered and payment decreased.

“Post-intervention studies were reimbursed substantially faster than pre-intervention studies owing to decreased need for resubmissions with additional or more appropriate history after initial rejection,” Ali et al. wrote.