Diagnostic Imaging Patient Registration Software

Patient Registration in a Diagnostic Imaging Practice

Registration at an imaging center starts with an order, not a phone call from the patient. The order names the study, the reason and the clinician who wants it. Patient registration software turns that order into a clean record. Staff look for an existing chart first, matching on name, birth date and member ID, so a returning patient keeps one history. Insurance cards are scanned and eligibility is checked against the payer. The ordering provider is captured as a person, with an individual NPI, since claims for ordered imaging are checked against Medicare's enrollment records. Registration also asks where the patient is staying. A hospital inpatient or a nursing facility resident in a covered Part A stay is billed differently from an outpatient. Patients who choose to pay on their own are flagged for a good faith estimate. What registration captures then flows into imaging patient management and into the pre-visit intake forms.

Why Is Patient Registration Different in Diagnostic Imaging?

The person who orders an imaging study is usually not on the imaging center's staff. That makes the ordering provider a registration field, not a background detail. Medicare checks claims for ordered imaging against its enrollment data. The ordering clinician needs an individual NPI. They must also be enrolled, or opted out, in an eligible specialty. A group NPI, a misspelled name or a nickname can sink a claim for a scan that was done well.

Payer details carry more weight too. Many commercial plans route CT, MRI and PET approvals through a radiology benefit manager, and the plan card may not say so. Registering the wrong plan, or an old one, sends the approval request to the wrong place. Plan rules also differ by product, so one payer may require approval on its commercial plans and not on its Medicare Advantage plans for the same scan.

Patient status is the third fact registration must get right. A patient who arrives from a hospital bed, or from a nursing facility, may not be billable to Medicare by the imaging center for some studies. Accident and work injury cases bring auto, no-fault or workers' compensation carriers, whose rules vary by state. Patient registration in imaging sorts these out before the scan. The best time is while the patient or the referring office is still on the line.

What Diagnostic Imaging Patient Registration Software Handles

Medicare ordering eligibility (PECOS)

To order imaging that Medicare pays for, the clinician needs an individual NPI, an approved or opt-out enrollment record and an eligible specialty. Organizational NPIs can't be used to order. Registration stores the individual NPI on each order, so staff can check it before the claim. (CMS: Ordering & Certifying (Medicare enrollment requirements for ordering providers))

Ordering provider edits (N264, N265)

Claims from imaging centers for ordered procedures are checked for a valid individual NPI and name. Missing or invalid details return remark codes N264 or N265. The name is captured as first and last name, with no nickname or credentials, to match enrollment. (Noridian Medicare JE Part B: PECOS ordering and referring edits)

Item 17 with qualifier DK

On the CMS-1500, the ordering provider goes in item 17 with qualifier DK. A paper claim with several ordering physicians is split, one form for each. Registration keeps the ordering provider on each study, so claims are built right either way. (CMS Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 (Items 17 and 20))

SNF Part A residents

For a nursing facility resident in a covered Part A stay, the facility bills the technical component of most radiology, and Medicare pays it through the SNF payment system. CT, MRI and angiography are excluded from that rule. Registration records the facility and the stay, so staff can tell which studies the center may claim itself. (CMS: Skilled Nursing Facility Consolidated Billing (excluded services))

Good faith estimates for self-pay patients

Patients who are not using insurance should get a good faith estimate when they schedule ahead or ask for one. Registration marks the patient as self-pay, which starts the estimate before the exam. (CMS: What is a good faith estimate?)

Plan-specific radiology approval rules

UnitedHealthcare lists CT, MRI, MRA, PET and nuclear cardiology for possible prior authorization, but says CT, MRI and MRA need none on its Medicare Advantage and D-SNP plans. Registration captures the exact plan, so the right rule applies. (UnitedHealthcare: Radiology prior authorization)

How Does Diagnostic Imaging Patient Registration Software Work?

1. 1. Start from the order

   The order arrives by fax, phone, e-mail or electronic interface and is matched to the patient. Staff record the study, the reason and the ordering clinician before anything else.

2. 2. Find or create the record

   A duplicate check on identity fields runs before a new chart is made. That keeps a patient's prior studies together for later comparison.

3. 3. Capture insurance and plan type

   Card images are scanned and eligibility is checked with the payer. The plan type is recorded, since it decides whether prior authorization runs through a radiology benefit manager.

4. 4. Record status and liability

   Registration asks whether the patient is a hospital inpatient, a nursing facility resident or an outpatient. Accident and workers' compensation details are captured with the carrier, since those claims follow state rules.

5. 5. Hand off to intake and clearance

   The finished record sends forms to the patient through intake. The payer and order details go to imaging financial clearance to check benefits and approval.

Diagnostic Imaging Patient Registration Software vs. Generic Software

Who Uses It in a Diagnostic Imaging Practice

• Registrar or scheduler: One screen for the order, the patient and the plan, with the fields that most often cause imaging denials checked at sign-up.
• Billing team: Claims that already carry the right ordering NPI, payer and patient status, so fewer come back with remark codes.
• Referring offices: Fewer callbacks, because missing order details are asked for once, at registration, instead of after a denial.