“High Touch” MRI Imaging Center Management, The Foundation of Profitability and Sustainable Success!
Stephen Veals
CEO MRI Consulting Group
August 29, 2024
What you may already know about Ensuring MRI Profitability.
MRI Imaging Center Profitability requires that you have sufficient MRI Scan Volume, earn acceptable revenue per scan, and have your Imaging Center Expenses under control (Ideally equal to 47% or less of expected annual center revenue). All of these should be consistent with the financial and business viability analysis that you will have created early in the project planning process to plan for the profitability of your MRI imaging center.
However, profitability is perpetuated over time and achieved at the most substantial level when implementing the most competent and actively involved MRI Imaging Center Management process!
Experienced “High Touch” Imaging Center Management is The Critical Foundation of MRI Imaging Center Profitability and Success!
What does this mean? You will want to employ an actively engaged Imaging Center Manager-Director who is at the MRI Imaging Center site each business day, knows the many critical details of the business of MRI Imaging, and is focused very specifically on the profitability of your MRI Imaging Center business! They are involved and will know and track the imaging center metrics you need to capture and evaluate for success every day. When I sit with the MRI Imaging Center Manager-Director, who knows this process very well, I can see how their work will result in a very profitable financial statement at month's end!
The most successful MRI Manager-Directors are High Touch; they are involved, truly hands-on, knowledgeable, and know what is happening at all times at their MRI Imaging Center!
Conversely, I have personally seen Manager-Directors who were not fully engaged in the business of the MRI Imaging Center or were insufficiently experienced, motivated, focused, supported, or directed, and over time, this had a profound negative effect on the Profitability and success of the Imaging Center! I have known MRI Imaging Center Managers who were asked to go off-site and work with other non-MRI Imaging Center medical practices, taking them away from what mattered at the MRI Imaging Center, which they were still employed to manage successfully and profitably.
The MRI Imaging Center Manager-Director is a full-time, critically important position.
You will want to give your carefully selected MRI Imaging Center Manager-Director this very significant job to complete, supporting them in their 100% focus and engagement in managing and directing your MRI Imaging Center. Doing so will reward you by seeing your diagnostic imaging center flourish profitably!
Where is the “High Touch” Experienced MRI Imaging Center Manager-Director?
Finding a High Touch, Hands-On, Experienced MRI Imaging Center Manager-Director requires finding a candidate with the best skills, experience, and attitude. This is consistent with individuals in the CEO/Administrator role or COO role of a leading-edge specialty practice, such as an Orthopedic, Spine, Musculoskeletal, Neurosurgical, Gastrointestinal, or Surgical Practice. If they have previous experience facilitating strong profitability when managing other physician-owned ancillary revenue businesses such as CT, Mammography, Physical Therapy, or Ambulatory Surgery facilities, so much the better; you will want to interview them and, if satisfied and with excellent references in hand, hire them!
As your MRI Imaging Center is an Imaging-Based Medical Practice that, in most instances, will reside inside one of the medical specialty practices noted above, chances are good the CEO/Administrator of that group has many of the skills we will be looking for in the Manager-Director position!
However, they may also have 200 other items they are responsible for as the CEO of the group as well and cannot commit fully to close management of the MRI Imaging Center and to take care of the other full-time business items they are responsible for as the group practice CEO.
So, where do you go from there?
What commonly occurs is that you will find an applicant with the most significant amount of the skills, direct experience, and attitudes necessary to fill the requirements for the MRI Imaging Center Manager-Director and the specialty medical practice CEO, who can oversee their work each day. They may have previously held the COO, Administrative Director, or the second or third most administrative position in one of the medical specialty groups previously mentioned. If so, with reliable, professional references and experiences confirmed, they may be an excellent choice for your MRI Imaging Center Manager-Director!
We have worked with our MRI Imaging Center client groups to assist them in finding high-quality Manager-Directors.
Skills, Experience, and Attitudes in Your Successful Manager-Director
MRI Prior Authorization is critical for your MRI Imaging Center Manager-Director. It does not simply mean calling the insurer and asking them to approve the MRI scan. It means researching and becoming familiar with the medical policies of the insurers with which you are contracted beforehand. Each insurer will often post their specific Medical Policy and Prior Authorization Requirements online. Failure to comply with these requirements before the MRI scan is performed can result in payment for the MRI scan being denied, and typically, your practice will be prohibited from billing the patient for the MRI Scan. A solid working relationship must be developed with each insurer, insurer gatekeeper entity, and your MRI Imaging Center.
Your MRI Imaging Center Manager-Director will need to meet with and educate the Physicians, Physician Assistants, Medical Assistants, and the entire front and back office team on how to effectively manage and respond to insurer requirements for MRI Scan Prior Authorizations.
Again, each insurer will have specific medical policies that the Manager-Director must be familiar with. Your Manager should be able to explain to all clinicians what each insurer group views as a medical necessity for scans and procedures and how the center intends to navigate the process to obtain authorizations for your scans successfully. It can be done very well and to your benefit. Ensuring your MRI Imaging Center Manager-Director knows how to master this process will result in a prosperous MRI Imaging Center!
Appeal of Denials for Prior Authorizations
This requires all of the experience and knowledge for the process of MRI Prior Authorizations and additional skills in working with the Insurance Company ascending clinical hierarchy for appeals. This includes having experience working with the insurance company medical director if needed and the ability to speak directly to the insurer group medical policies related to prior authorizations. The appeal of Insurer Denials for Authorization of an MRI scan can and must be professionally managed by a skilled MRI Imaging Center Manager-Director, frequently in close communication with the physician ordering the MRI scan in question.
A Knowledgeable, Persistent, and Efficient Manager-Director
The Manager-Director must be knowledgeable, persistent, and efficient in managing the necessary prior authorization process for MRI scans and the appeal of denials.
Again, this will be handled within the medical policies of each insurer. Nothing can languish in this process. Timeliness in scan authorizations, appeals, and accurate claim submissions for payment are fundamental to the profitability of your MRI Imaging Center.
Proficiency in Procedural Coding and all things Billing and Collections Related
Your MRI Imaging Center Manager-Director should know the CPT codes for the various MRI exam scans and ensure that the claims are accurately coded for submission in the billing and collections process. Finding a certified Certified Professional Coder (CPC) candidate would be a plus!
Claims Submissions and Internal System Audits
You will want the MRI Imaging Center Manager-Director to ensure 100% of daily claim submissions are correctly coded with accurate patient and insurer information. A daily audit of the exact claims submission from your MRI Imaging Center is also fundamental.
Review and Resubmission of all Claim Denials
You want to avoid seeing denied claims due to failing to meet timely filing limits and other insurer requirements. Eligibility denied is different from what you want to see on patient claims from your insurers. Your front office check-in process for the MRI imaging center must always document and verify client insurance status and accurate patient demographics. Your MRI Imaging Center Manager-Director must implement effective and up-to-date front office policies and procedures. With a patient check-in every 20 to 30 minutes, the manager can easily oversee the client’s MRI scan check-in process and all that is needed for an error-free and pleasant patient encounter.
Understanding the Importance of the Patient Portion of MRI Scan Reimbursement
When I evaluate MRI entities that are financially underperforming, I sometimes find a center that needs to fully understand the patient's financial responsibilities for their MRI Scan. This is where it can be critically important to understand the managed care insurer agreements that your MRI Imaging center has agreed to. Your MRI Imaging Center may have a contract with an insurer that states, for instance, that the MRI scan you are performing on their enrollee in your facility will be reimbursed at the rate of $800 for the patient's MRI scan. However, look closely at the agreement with that insurer. $500 may be paid by the insurer, for instance, but your facility will also need to collect an additional amount from the patient of $300 to receive the total amount of $800 you were expecting to receive!
Failing to capture patient MRI scan copayment amounts can affect your MRI Imaging Center's profitability!
Your MRI Imaging Center Manager-Director must understand insurer agreements and the dual process of patient responsibility and insurer responsibility in the billing and collections process. They should also always inform the patient of their financial responsibility before the MRI Scan.
Management of MRI Imaging Center Expenses
You will want to ensure that you have an MRI Imaging Center in which your Manager understands your center expenses and the expense-to-revenue percentage expected to facilitate profitability for your MRI Center. Managing Center Expenses effectively can keep you from unpleasant surprises when expenses are left to manage themselves, which does not usually go well. In the initial six months of operations at the start of a new MRI Imaging Center, you will find more expenses than incoming revenue. However, that should reverse in the second six months of the year, and revenue will become more normalized. You should see normalized monthly income by the end of the first year of operations. Based on my experience in the review at year-end of the most successful MRI Imaging Centers, the goal is expense levels that are at most 47% of the revenue coming into the center, and lesser amounts are better, of course! This relates to all expenses for the center, staff salaries, wages and benefits, and the equipment and buildout expenses.
Your MRI Imaging Center Manager-Director will need to understand and be familiar with all of the numbers and projections in your Financial and Business.
Viability Proforma developed before your MRI Plan, Design, Build, and Implementation for your MRI Imaging Center. Doing so will allow them to understand when your expenses are in line or out of line with the business expectations for your MRI Imaging Center, and the appropriate business responses can be implemented on behalf of your MRI Imaging Center.
Prepare your MRI Imaging Center for Sustainable Profitability and Success!
Search for, retain, and fully support your “High Touch” MRI Imaging Center Manager-Director! Do not gamble on your MRI Imaging Center's success; invest, support, and grow this exciting and rewarding Medical Business Opportunity! There is more to the process than many folks might imagine. The centerpiece of your profitability and success is an excellent Manager-Director, “High Touch,” in all the areas and ways we have outlined in this article. Feel free to reach out for further information or assistance!
When you take advantage of our consultancy guidance and expertise in developing your MRI Imaging Center, we review this process for our clients. We can always ensure that they are on track for sustained profitability!
Additionally, we mentor and provide training assistance to the Manager-Directors for our MRI Imaging Center clients whenever requested!
We look forward to assisting you in the professional search and development of your “High-Touch” MRI Imaging Center Manager-Director.
Your Success is our Success!
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