HAP Radiology Billing and Coding Blog

The Coastal Imaging Success Story Part 1: The Transition

What does it take to unite three radiology groups and 38 providers into a new entity, secure favorable terms across a complex carrier mix, and serve a diverse patient population at four hospital locations? Working relationships. That’s how Coastal Imaging came to be from the merger of three independent groups. That’s the reason their collective KPIs improved across the board immediately following the transition. And that’s all because Coastal teamed up with a true business partner, not a billing vendor, to empower their financial future...

 

It’s Not Too Early to Prepare for a MIPS Performance Data Audit

Beginning in 2019 the level of reimbursement from Medicare to many physicians will be determined in part by their performance in the Merit-based Incentive Payment System (MIPS).  Medicare will award a higher level of payment to those eligible clinicians and groups who report that they have successfully met certain criteria for Quality, Advancing Care Information, and clinical practice Improvement Activities.  MIPS is the successor program to the Physician Quality Reporting System (PQRS) and Meaningful Use of Electronic Health Records (MU-EHR) incentive programs, and CMS (the Centers for Medicare and Medicaid Services) has indicated that it will continue its practice of auditing the data submitted by practices just as they did under the earlier programs.  As this article in Healthcare IT News illustrates, the result of failing an audit will be non-payment of expected incentives (in the case of a pre-payment audit) or returning of funds already paid and possibly even federal sanctions depending on the severity of the infraction. 

Categories: MIPS, Quality Payment Program, MIPS participation, radiology, quality measures

Exceptions and Exemptions from MIPS Reporting for 2017: What Radiologists Need to Know

In the August 4, 2017 edition of its Advocacy in Action eNews the American College of Radiology (ACR) reported on the Centers for Medicare and Medicaid Services (CMS) announcement regarding the manual application process for a significant hardship exception under the Advancing Care Information (ACI) category of MIPS

Categories: MIPS, MIPS participation, radiology

CMS Issues Its Proposed 2018 Medicare Physician Fee Schedule Rule

The annual regulatory cycle of review, comment, planning and preparation has begun with the release of the Medicare Physician Fee Schedule (MPFS) Proposed Rule for 2018. In its preliminary review of those sections of the MPFS that will be of specific interest to radiology practices, The American College of Radiology (ACR) includes a statement that “the ACR is pleased with several provisions within the rule.”  They highlight the planned implementation of the Appropriate Use Criteria and Clinical Decision Support rules beginning January 1, 2019 and the proposal to leave the technical component of mammography services unchanged rather than lowering it by 50% as previously discussed. 

Categories: radiology reimbursement, cms, MPFS, radiology

New Information on the Medicare Rules for Appropriate Use Criteria and Clinical Decision Support

New information has been provided by The Centers for Medicare and Medicaid Services (CMS) that will supplement our article An Update for Radiologists on Appropriate Use Criteria and Clinical Decision Support.  We can now update you from the recent release of the “Proposed Medicare Physician Fee Schedule (MPFS) for 2018” and the “Proposed Rule for Quality Payment Program Year 2.”

Categories: radiology reimbursement, clinical decision support, radiology, appropriate use criteria

Successfully Collecting for Imaging Services to Skilled Nursing Facility Patients

Patients in rehabilitation facilities sometimes need imaging services that cannot be provided within the facility itself. Imaging centers willingly accept these patients but they can inadvertently fall into a collections quagmire if they aren’t aware of the Medicare rules related to skilled nursing facilities.

Categories: radiology reimbursement, radiology, skilled nursing facilities

Pros and Cons of Utilizing Teleradiology Services

Radiologists considering the use of an outside service for final reads will have questions that include not only quality and cost but also the impact on the group’s relationship with its hospital and referring physician community. The answer will not be the same for every radiology practice.  Here we present some of the pros and cons for consideration in the decision-making process.

 

Categories: radiology billing, radiology, teleradiology billing, teleradiology

Best Practices in Radiology Patient Billing

 Maximizing the patient experience is no longer limited to the achievement of clinical success. It is a critical component of the new, broader partnership between provider and patient – one that now encompasses conversations regarding not only service quality and cost, but also places a greater focus on practice billing processes in line with the higher demands inherent to the new patient consumerism trend.  

 

Categories: radiology reimbursement, radiology billing, patient collections

Exempt from MIPS?  Think Again About Participating as a Group

With the first year of the Merit-Based Incentive Payment System (MIPS) already well underway, the Centers for Medicare and Medicaid Services (CMS) began sending out MIPS Participation Status Letters in April. The letters were sent to each Eligible Clinician (EC) associated with a group Taxpayer Identification Number (TIN).  An EC can also check the Medicare Quality Payment Program (QPP) web site to determine his or her eligibility.  The letter and web site contain general information about participation in MIPS, along with email and telephone contact information that should be used if a provider feels his or her status is incorrect.

Categories: medicare reimbursement, MIPS, MIPS participation

An Update for Radiologists on Appropriate Use Criteria and Clinical Decision Support

Radiologists are understandably nervous about the Medicare rule requiring the use of Appropriate Use Criteria and Clinical Decision Support (AUC/CDS) systems. 

Categories: radiology reimbursement, radiology documentation, clinical decision support, CDS

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