Although groups representing diagnostic imaging providers generally do not endorse the use of radiology benefits managers (RBMs) to control utilization of imaging services, they do recognize the RBMs’ role in utilization management. Given that, the American College of Radiology (ACR) and the Radiology Business Management Association (RBMA) recently developed best-practice guidelines for groups that use RBMs.
The guidelines include recommendations that pre-certification should cover a family of codes rather than a specific CPT code, that there should be a mechanism for approval of after-hours tests, that accreditation of imaging equipment and technologists should be required, and that RBMs should offset the additional costs associated with pre-authorization incurred by the ordering/referring physician. The groups also recommend that imaging services that are approved by the accepted pre-authorization process should not be denied after the fact and that when the radiologists are not in control of the pre-certification process, the professional component of a procedure should be paid by the insurance company even if the claim is denied on the basis of pre-authorization.
June 2009 - Table of Contents
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