Health Care

Ordering Patient MRI & CT Exams: What To Do & What NOT To Do

Ordering Patient MRI & CT Exams: What To Do & What NOT To Do | Dr. Cristin Dickerson

In 2011 the Office of Inspector General conducted a nationwide audit of emergency department patients and discovered that 12 percent of all MRI and CT exams as well as 9 percent of all X-rays had no orders in the medical record. Naturally, they recommended that Medicare request a refund back for every one of these services.

The truth is, radiological exam orders continue to be a challenge for both health care organizations and doctors alike. How should a radiologist proceed if the order given doesn’t match a patient’s actual needs? A simple question that belies the complexity of the compliance issues it could engender.

Orders Via Medicare

Requirements for services ordered in a hospital setting can be found in the Medicare Hospital Conditions of Participation (COP), which can be found in 42 CFR §482.26(b)(4). 42 CFR §482.26(b)(4) and essentially mandates that all services provided by the hospital must have an order in the patient’s medical record, and the order must match what was provided.

Additionally, the COP explicitly states that only a practitioner with “clinical privileges” can order the services in question. What this means is that if a hospital governing body has authorized you, the doctor, to order services for patients, those orders are now valid under the COP.

Diagnostic tests can only be ordered if deemed “medically necessary.” Furthermore, if an order is changed from what was originally requested, the medical necessity of the change also must be documented to support the revised order.

“Great MRI service. Affordable. Professional. This is the way healthcare should be. I highly recommend this company.”

Trevis Bonnett, Patient

Common Exceptions to Medicare Orders

Of course, there are exceptions to the rules laid out above, and it would be helpful to understand how these exceptions might play out in a hospital setting.

  1. In the case of Medicare orders that do not specify the exam protocol, the radiologist may make what is known as a “test design decision.” This allows a radiologist or other authorized medical professional to determine how the test should be performed based on the patient’s clinical indications without notifying the referring physician.
  2. The radiologist may also make changes to the order when an obvious error is present such as a test order for an X-ray of the left foot when the right foot is clearly injured.
  3. If the patient’s physical condition does not allow for an order to be carried out, the radiologist may cancel it.
  4. Medically necessary “scout” images, or images made to allow another procedure to proceed, are also permissible (and billable) under Medicare.

Obviously, many of these exceptions that may apply to Medicare orders might not apply or be permissible according to your facility guidelines. Remember, individual payer guidelines always prevail.

Non-Medicare Orders

Commercial payers generally require precertification, also known as preauthorization, before diagnostic exams, such as MRIs, CT, and PET scans can be ordered and administered. It is typically the referring physician and his staff’s responsibility to obtain this preauthorization from the payer by providing the requisite medical reason for the order. Because the referring physician owns the patient’s medical record, it is critical that he or she obtains the approval and retain documentation indicating why the exam was ordered so as to minimize any potential conflicts of interest. Incorrect orders must be sent back to a referring physician and replaced with a new order or precertification.

We Offer Concierge Level Radiological Services

If you are a physician or medical facility and would like to refer a patient, please provide your order via EMR, fax or our convenient app, Green Patient Connect. We'll handle scheduling, pre-certification, and patient prep. We'll also keep you updated on the status of you patient's exam, and provide customized reports via our PACS portal or the delivery method you prefer.

"I couldn't recommend Green Imaging enough! The service was invaluable at a critical time for my family member, and exceeded our expectations. As an uninsured patient, my (visiting from abroad) family member was able to get a reasonably-priced MRI done, and I received exceptional service from the Green Imaging team. From making an appointment for us on a short notice to getting the radiologist's report within a couple of days, the Green Imaging team was a godsend. Will definitely use their services again if the need arises, and strongly recommend to anyone looking for great imaging services."

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Jill C.

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"This is the second time I've used Green Imaging. Both times my appointments have been scheduled quickly at convenient locations around my availability. Leo was my most recent scheduler and my appointment was made within a couple hours of submitting my physician's orders."

Betsy M.

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"Wonderful service, the way they please customers is amazing. I thank Leo for his efforts and accuracy."

Diane T.

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"This service is amazing and I appreciate it and the service I received so much. This is the 2nd time I've had to get an MRI and they made it so easy to get the appointment at no cost to me. Margo was the rep who helped me and was so professional. Thank you all so much."

Jody C.

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"Very easy and prompt service. I text my request and got an immediate response. I simply had to take a picture of the order, provide my zip code, and list 3 available dates and times. Bada bing bada boom! Appointment was scheduled, I received a text to confirm, I confirmed and off I went to my appointment two days later. No calls.... very quick and easy! I loved it!!"

Diane C.

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"It worked out great as I was able to get my needed MRI for free and they worked with me to find the right place. They even got me in within a couple days of my request. I completely recommend them."

Jennifer G.

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I cannot recommend this company enough for affordable radiology services. After insurance sent me to a clinic that wanted $1400 for a knee MRI, Green Imaging hooked me up with a local imaging clinic. I had a great experience, and my MRI only cost me $350. I have never been more impressed with client/guest services than I was with Nataly who I emailed at 4:30 in the afternoon to let her know she should be expecting my MRI order from my doctor by the next morning. By 10am the next day she had already called them to follow up when she had not yet received it. Her responses to my questions were so quick. There was never any waiting around, and she even scheduled my appointment at the clinic for me. Hopefully I won't need to use them again, but if I had to I definitely would.

HAVEN N.

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Travis B. - Testimonial

"Great MRI service. Affordable. Professional. I will continue to use them in the future. Very affordable in contrast to MRI's and cat scans at hospitals. This is the way healthcare should be. Having the ability to know about your cost upfront. I highly recommend this company."

TREVIS B.

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I cannot say enough nice things about this facility and the staff. I needed an MRI, however I have a high insurance deductible, therefore I had to pay out-of-pocket. Green Imaging and Dr. Dickerson offered very reasonable rates for this situation. Dr. Dickerson emailed me directly and was very accessible.  The staff were pleasant and well trained.

The young man who did my MRI was so nice.  I was very nervous as I have a bit of claustrophobia, he talked me through the procedure and made me feel safe and comfortable. My results were available to my physician the same day.

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