Reads the scans
the Physician Group
Radiologists on call. They produce the report.
Problem → Dashboard → Solution
You're already generating the data. You're just not seeing it.
Every read writes a claim, a report, and a set of timestamps to systems you already pay for. The economics feel invisible not because data is missing, but because nobody has joined it. This shows what happens when you do.
The Problem · Follow the fall
Reading scans nobody pays for — everywhere.
Owns the floor
the Hospital
Operates the imaging suite. Bills the technical fee.
Orders the scans
the ED
Emergency physicians under acuity pressure. They decide what gets imaged.
This is the shape of the modern radiology partnership. A physician group reads for a hospital system under contract. The hospital mandates emergency, trauma, and overnight coverage. Payer mix means a large share of that volume never collects — and the group eats the labor on every read regardless. If the hospital isn't paid, neither is the group.
Reimbursement is falling in real terms. The Medicare conversion factor — the dollars-per-RVU that anchors every read — was $32.35 in 2025 and is $33.40 (non-QP) / $33.57 (QP) for 2026, the first year of split factors.[1] On top of that, CMS finalized a −2.5% efficiency cut to work RVUs on non-time-based codes for 2026, which lands directly on imaging.[2] The rate per unit of work keeps eroding — while the mandated, uncollected coverage volume doesn't.
The old fear was that AI would replace radiologists. The opposite happened. AI made reading faster but concentrated the radiologist's real value in diagnosis, communication, and procedures — while imaging demand exploded and radiology became the bottleneck. Groups are more valuable now, not less. Yet they're still structurally underpaid for the mandated coverage that doesn't collect.[4]
There was one federal lever that could have curbed unnecessary ordering — Medicare's Appropriate Use Criteria program, which required ordering clinicians to consult decision-support before advanced imaging. Effective January 2024, CMS paused it and rescinded the regulations, with no restart date. It's statutorily mandated, so it could return — but for now there's no regulatory brake on over-ordering. The fix can't wait for Washington; it has to be operational.[3]
A small vignette
A patient arrives, coded 'fall.' That one word reflexively unlocks a head and C-spine CT — often low-yield, frequently uncollectible. Watch that single scan travel through all three stages. It's the whole story in miniature.
The Dashboard · The fall, in numbers
You're already generating all of this.
One view. Joined across the systems that already record what happened. The number is not new. The seeing is.
Foundation meter
9 of 9 panels wired from data you already own
Illustrative · sample data
★ count + $ · [p1][p7] · two-domain join
Lost-study reconciliation · found money
1,500
unbilled reads / yr
$53K
at $38.96/wRVU · blended
Completed reads (worklist) − billed reads (billing). Work already done, charge never dropped. ~100% margin. Default ≈ 1.0% of 150,000 reads — illustrative; 0.5–1.5% typically slips until the join reveals it.
% · [p1]
Net collection rate
92.4%
collections ÷ allowed
$/wRVU · [p1][p5]
Net revenue per wRVU
$38.96/wRVU
blended · across payers
% shares · [p1]
Payer mix
Commercial33%
Medicare22%
Medicaid30%
Self-pay15%
wRVU + $ · [p1][p5]
Coverage gap vs Medicare
$1.11M
33,210 wRVU · no-pay + shortfall
% by CARC · [p2]
Denials
7.2%
- CO-50 · not medically necessary · 38%
- CO-97 · bundled / inclusive · 22%
- CO-16 · missing info · 14%
days · [p1]
Days in A/R
38 days
AR ÷ avg daily charges
% · [p6]
Negative-read rate · fall
55%
fall · clean reads ÷ reads
minutes · [p7]
Turnaround time
28 min
STAT · signed − complete
Provenance · endnotes
- p1 — 837/835 claim and remittance feeds (billing-domain truth).
- p2 — CARC/RARC denial codes from 835.
- p5 — CMS public RVU file (CPT → wRVU).
- p6 — Reporting platform (mPower export or NLP over PowerScribe text).
- p7 — PACS timestamps (exam_complete → report_signed).
Same component as Under the Hood — here in a representative, fully-wired state. Tune the questionnaire there to watch panels flip.
The Solution · The fall, removed
Everyone earns more by removing waste.
Not a negotiation. Not 'we have better numbers, so renegotiate.' It's the hospital and the group both adapting to the new reality — where all parties earn more by cutting waste, in full legal compliance. Fewer unnecessary unpaid scans, faster throughput, and capturing the reads that are payable.
01
Collaborate
Ordering-side support in the ED and radiologist-led appropriateness. Accurate indication capture — so the fall that shouldn't be scanned, isn't. Voluntary decision-support, which CMS now encourages, future-proofs the group if AUC returns.
02
Quantify
A shared fact base both sides trust. The dashboard, jointly owned, so nobody argues about whose numbers are right.
03
Structure
Any coverage arrangement built fair-market-value and anti-kickback clean from day one. Compliance is the foundation, not an afterthought.
$69K
TO THE GROUP / YR
$436K
TO THE HOSPITAL / YR
1,980
FEWER NEEDLESS SCANS / YR
Illustrative sample data. Tune the inputs in The Sandbox.
What becomes possible
Once you can see it, here's what opens up.
None of this needs new systems or AI. It needs the join — and the join is cheap.
possibility
Found studies
Reads completed but never billed, surfaced by joining worklist and billing — recovered dollars into the pool.
possibility
Underpayments caught
Commercial claims paid below contracted rate, flagged against the contract — recovered dollars into the pool.
possibility
The denial pattern, fixed
One CARC, one workflow tweak, one report — recovered dollars into the pool.
The structural lever
And the biggest one isn't a leak — it's getting paid for the coverage you're already required to provide.
Because recovered dollars are near-pure margin, they land in the bonus pool — the number a partner feels. The do-first moves build the credibility and the cash to win the structural one.
Illustrative. The moves are hypotheses the data tests — yours to choose.
Sources
- [1] Medicare conversion factor — CMS finalized CY2026 factors of $33.40 (non-QP) and $33.57 (QP), up from $32.35 in 2025 (first year of split factors). CMS CY2026 Physician Fee Schedule Final Rule (CMS-1832-F), Oct 31 2025.
- [2] Work-RVU efficiency adjustment — CMS finalized a −2.5% efficiency adjustment to work RVUs for non-time-based services beginning CY2026, applying to imaging codes. Same CMS CY2026 MPFS final rule.
- [3] Appropriate Use Criteria — paused and the regulations at 42 CFR 414.94 rescinded effective Jan 1 2024, no restart date; statutorily mandated under PAMA, so subject to future reinstatement. CMS Appropriate Use Criteria Program.
- [4] Radiologist workforce / demand — the ACR projects substantial U.S. radiologist workforce growth through 2055; the field expanded rather than contracted after AI adoption. ACR workforce analysis, 2025.