New Issues Highlight Need for RAC Strategy

Adenosine Dose vs. Unit Bill

Adenosine billing is billed incorrectly when the dose does not match the unit. "Adenosine 30 mg is a billing unit. If a patient receives 50 mg as two units, the billing is out of compliance," she says. To avoid such issues, the director of nuclear medicine would assess the billing for compliance and notify finance of a bill hold if billed incorrectly," says Lamkin.

Lamkin advises providers to assess their risk, and then coordinate any charge master changes with pharmacy and finance. "The issue should then become a performance improvement indicator for the department of nuclear medicine to track and report its compliance."

For a facility to be compliant with these issues, all levels of the organization must be involved in billing compliance. In addition, staff members, and in particular department directors, must understand the rules and be accountable for their charger master, according to Lamkin.