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PAMA compliance and imaging integrity

Ronnie Sutton (ronnies@ipro-inc.com) is a Partner and Director of Software Services at iPro Healthcare, located in Calhoun, GA.

Ambulatory encounters and patient leakage are two areas that are prone to significant revenue loss for hospitals and health systems. Upcoming compliance mandates related to advanced diagnostic imaging services under the Protecting Access to Medicare Act (PAMA)[1] stand to compound ambulatory revenue threats in the near future. This makes ambulatory order and referral management key targets for process improvements as hospitals seek to meet compliance requirements and protect vital funds.

As patient reengagement in ambulatory services continues to climb after the deferral of many medical procedures during the COVID-19 pandemic, now is an ideal time for healthcare provider organizations to implement measures to guard against revenue threats related to PAMA compliance. This can be achieved by reinforcing workflows associated with ambulatory throughput in order to drive efficiency, reduce the chance of patient harm and denials, and ensure the healthcare organization and its community partners are prepared to comply.

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