Overcoming Insurer Obstacles To Your In-Office MRI
Stephen Veals
CEO MRI Consulting Group
May 12, 2024
If you are a medical group with in-house MRI Imaging services, you have experienced Insurer Groups you have contracts with, who work to prevent you from using your own in-house MRI Unit for your patients.
Let us delve into the problem of Insurer Gatekeepers who work to slow walk, impede, dissuade, or create unrealistic bureaucratic obstacles to de facto deny physicians' use of their own MRI Services!
All insurers will have their standard corporate and clinical paperwork for the patient at the time of service and documentation requirements for scanning their insured enrollee.
Of course, the MRI patient prior authorization process for the scan of your patients will also be a prerequisite for the insured enrollee, your patient. In my experience, however, this process can be fast-tracked significantly, and requirements should be satisfied on the same day and within only several hours at most.
As it is being negatively experienced in many practices with most insurers, It is a delaying technique designed to wear down the medical practice and the patient, dissuade physicians from future ordering, delay practice patient treatment efficiencies, and create additional practice expenses.
In the years since I first became familiar with the MRI Imaging Center requirement for managed care organization approval for use of the physician group’s MRI unit and subsequent payment for the Clinical Diagnostic Examination of your patient on your fully credentialed and fully contracted MRI Unit, many things have not changed for the better.
The response to these gatekeeper insurer obstacles to using your own in-office MRI requires an assertive and systematic approach to be addressed by the Medical Practice.
For the insurer group, it is about making money…
They are in business selling insurance plans and need to make more money each year than the year before. They have shareholders and must improve their stock value each year. There remains constant upward pressure to improve shareholder values each year.
Nearly every year, insurer groups look to charge the purchasing consumer group more than they did the year before for the same set of insured services for their subscribers or, if necessary, offer fewer covered clinical services with more out-of-pocket expenses to the purchasing consumer group or entity.
For the Medical Group, it is simply about performing MRIs on patients in their treatment setting.
The insurer groups have seen that physician specialty medical groups have met the regulatory requirements under federal Stark Laws for the ownership and in-office use of the MRI and other Diagnostic Equipment. As such, medical groups with the necessary MRI scan volumes to sustain profitability are capturing their ancillary MRI scan revenues and have installed in-office MRI Imaging Services. Importantly, physicians with the diagnostic need and ability to perform MRIs on their patients in the comfort of their office setting. It is a win-win for the patient, their family, and the treating physician. Oddly, it is also a financial win for the insurer groups, as noted below!
Your MRI Imaging Center is reimbursed less than Hospitals and Medical Centers. You save the insurers money, but they fear Physician Groups who have an MRI will drive utilization up!
Your Medical Practice Imaging Services will almost always be reimbursed for your patient scans at a rate significantly lower than the local medical centers and hospitals that had previously performed the MRI on your patients, the insurer group enrollees.
You save the managed care insurer groups real money. That does not always matter to the managed care insurers, who seek to drive down utilization by physician groups for MRI and other Ancillary revenue-based care.
Real Solutions and Strategies can and must be implemented when Insurer Gatekeepers work to impede your ability and right to utilize your MRI Imaging Center!
You are far from powerless! As an owner of the MRI Imaging Center, because you have done what is right to perform MRIs under the law and now should be free to order and perform MRIs on your patient, we recommend that you obtain some additional consulting assistance and implement some fundamental Strategies and Solutions to this problem.
There are tools, techniques, behaviors, and a significant continuum of responses you can employ to reverse and thwart the activities of Insurer Gatekeepers who seek to decrease the utilization of your own MRI Imaging Center! You can overcome the insurer obstacles.
We can work with your MRI Imaging Center Team to create clinically specific responses, educational tools for your staff members, and instructions and responses to overcome the impediments, foot-dragging, and obstructive behaviors employed by various gatekeepers to prevent you from freely and without obstacles using your own MRI Imaging Centers.
We have a great deal of experience we can bring to assist you!
We have discussed the opportunity and the reward for implementing the Physician-Owned MRI Imaging Center in the past!
Let us help you maximize the Opportunity and Reward!
Schedule a complimentary phone call for more information.
Please read the following pages for more in-depth information:
Insurer Agreements – Full Service – 12