Practical Tips regarding MRI'S

If you are billing PIP insurance and referring for MRI’s here are some practical tips to avoid getting sued by an insurance company.

1. Stay away from MRI Centers that only have an “Open MRI” machine:

When you hear “open MRI” I want you to think “this machine hasn’t been made since the year 1999.” Then I want you ask yourself, would you watch your favorite show on a TV from the year 1999. The technology from 1999 really sucks compared to today’s technology.

Did you know that open MRI machines were largely discontinued around 1999 because they miss a large number of injuries to the shoulder/knees/joints? The image quality is too grainy to pick up many of the ligaments in the joints. I thought you sent patients for an MRI because you wanted to find out if they had injuries…not to miss them.

You should send your patients to a 1.5T or 3.0T scanner first. An open MRI is usually a .2T or .3T which means a 3.0T machine is ten times as strong! If they can’t be scanned in a 1.5T or 3.0T MRI it will be because they are too large or they panicked and aborted the scan. Only those patients should be scanned on an Open MRI.

2. Stay away from mobile MRI machines.

The day of the mobile MRI in Florida is gone. Insurance companies presume the only people using mobile MRI machines are illegally paying for scans. I can throw a rock and hit three MRI centers anywhere in Florida. Why does a mobile MRI center need to be driven across state to scan patients at an auto accident clinic?

Insurance companies have sued doctors for referring every patient for MRI’s on the first visit. They say that the patient wasn’t given a chance to fail conservative care and that they might not have incurred the bills had the patient been given a couple of weeks of therapy.

This is not to say that you should not refer a patient for MRI on the first visit. The problem is when every patient is referred for MRI on the first visit. If a patient is limping, you should obviously refer for an MRI but every patient cannot need an MRI on the first visit. For example, why would you refer a patient with a level 2 pain in the low back for an MRI on the first visit? The insurance company will say that it is because you want to curry favor with personal injury attorneys by obtaining MRI’s early in treatment.

4. Make sure you document why they need an MRI/X-Ray

Write down in your patient chart why you are sending for an MRI/x-ray. Include the date you referred them for the MRI/X-Ray.

If the radiologist says “I see something in thoracic region and would like to get a dedicated thoracic MRI” then you need to refer for a thoracic MRI or write down your justification why. Insurance companies have sued doctors multiple times for referring for imaging and then not using the information obtained. It comes down to poor documentation. You don’t need to refer for the dedicated thoracic MRI in this example, but you should document that you saw what the radiologist wrote and why you chose it wasn’t necessary at this time.

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Practical Tips regarding MRI'S

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