Diagnostic Smackdown!


Of course there is always a fight in the world of medical bills. Here’s the most recent item and who it affects.


Anthem insurance company has launched a program to decrease the amount spent on CT scans and MRIs that are performed on an out-patient basis. In recent years these out-patient diagnostic services and the moneys they generate have become increasingly important to hospitals as they have seen in-patient revenue and other reimbursements decline. But hospitals charge significantly more for these services than do free-standing independent imaging centers.


The hospitals point to their additional overhead required by regulators. The free-standing centers point to the hospitals’ increased overhead required by regulators. And they also mention the hospitals’ use of imaging services in an attempt to balance their books.


Anthem is not as much concerned with motive as they are with absolute pricing. Free-standing facilities apparently produce acceptable quality for less money.


What we at OMCA are concerned about is whether you need the MRI or CT scan in the first place! Is this required by the nature of your injury or the lack of success shown by conservative treatment? Thorough and competent utilization review is critical in assuring you don’t pay for over-treatment. Don’t worry so much about the unit cost. Most states’ fee schedules for workers’ compensation take care of that.  Worry about whether you even need the unit.


Or don’t worry at all. Let us manage your utilization review program. We’ll ask the hard questions and demand the right answers before we approve the purchase of care.


Call us. We can do better.

William Faris, JD
Chief Executive Officer

Posted in Bill's Favorite Files, Medical Cost Containment, OMCA