Ever notice that there is always at least one or two cases that stick around on the worklist day after day? Perhaps, it was a complicated case for which someone is waiting for a consult. Or, maybe the technologist took the wrong MRI sequence and needed to bring the patient back. Regardless, you will see this all-too-familiar case on the worklist for what seems like eons at a time. But, at what point does the case become a hazard to the patient, institution, or radiologist? Is there a formal deadline for a final interpretation? Can radiologists even get paid for these ancient cases? And, at what point, do we need to bite the bullet and dictate the darn thing?
Believe it or not, this deadline for radiology case interpretation is a complex issue. It is not quite like the “best by” date on a package of bread. (although that date can be a little confusing as well!) And, like most complex issues in this world, the answer to how long you can sit on a case depends. Furthermore, I would go as far as to say that each case has several different shelf lives depending on the eye of the beholder. Each time is more relevant to a specific entity within the health care system. Let’s categorize them into the standard institutional time limit for the institution, the deadline for excellent patient care by the radiologist, the legal time limit for the attorneys, and the expiration time for reimbursement by the billers. So, let’s go into through what each of these means.
Hospital Statistical Deadline
Many of you have probably heard of the time to transcription. Well, that is an example of a statistic that many hospitals, practices, and institutions monitor closely. In some centers, if there is a case that goes past that typical time, the institution may flag it or call the doctor to let them know. Each institution has its numbers based on the type and the place performed. For instance, an ER x-ray may have a mean time to transcription of a few hours. And, a non-emergent MRI may have a typical time to transcription of 24 hours. We can consider those cases that significantly surpass these time limits to exceed the standards of the hospital or the credentialing societies. And, sometimes, this may be at a detriment to patient care. Other times, not as much. (depending on the case!) All this brings us to the next limit.
Quality Patient Care Deadline
OK. So, you’ve run past the “hospital statistical deadline.” But all is not lost. Depending on the situation, you may be well within the expiration date for quality patient care. Sometimes, it pays to wait past the hospital’s statistical expiration time. Let’s take, for example, an oncological CT scan that sits waiting for comparison. If you were to dictate it right off the bat, you would have a meaningless report. Why? The oncologist most likely wants to know if the lung cancer metastatic disease is better, worse, or unchanged. In this situation, you cannot provide that answer with only a single time point. So, the hospital statistical expiration time often does not necessarily match up with the time it takes for quality patient care.
Simply put, this time is when the radiologist or institution becomes legally responsible for any findings missed because of a lack of interpretation. This time frame is a little bit more shadowy and vague. To understand this expiration time, think about the nighttime floor film that has a pneumothorax. If you do not read this case in a reasonable amount of time, and the findings go unnoticed, you and your group can be in for some trouble. But, this legal time limit can vary depending on the situation. Indeed, if the clinician notifies a radiologist to read the film immediately, and the radiologist does not, that could be a cause for immediate liability. On the other hand, if the clinician ordered a study without any priority notification, the timing for radiologist liability can become a lot longer. Additionally, in any given case, the time of delay in interpretation that can cause radiologist liability can vary widely depending on the situation, location, and jury (if the case goes to trial!)
And then finally, we have the reimbursement expiration time. Believe it or not, this was difficult information to find on the web. In my opinion, it is because insurers do not want to advertise these dates. But, Scott Raley, the client service manager from Zotec Partners, gave me a few benchmark dates to remember. He stated that the reimbursement expiration time for Medicare cases is one year, and Medicaid is 180 days. For private insurers, this time can vary depending on the contract negotiated. But it typically ranges from 90-180 days. So, these times vary widely.
The Deadline For Final Radiology Interpretation- More Than Meets The Eye
Whew. So, there you have it. The shelf life of a radiology case can vary depending on the eye of the beholder. For the hospital, it’s one time. For the radiologist, it’s another. And if you are a lawyer or a biller, you will worry about other times of expiration. The bottom line is that you should be aware of all the consequences of those films that lag on the list forever. So, if you see one of these cases on the worklist, don’t just let sit. See if you can figure out why it’s there and follow it through to its conclusion. The patient, hospital, and radiologist will benefit immensely!