HAP Radiology Billing and Coding Blog

Maximize Mammography Coding and Billing Efficiency in 2017

Medicare publishes its rules and requirements for the coding and billing of medical procedures to obtain reimbursement under its programs, but many commercial insurers are not as transparent about their own requirements. This leaves medical billing professionals in the dark when there are new procedure codes or changes to existing coding in the American Medical Association’s CPT® code set or by federal regulation.  Such is the case with mammography coding for 2017.  Below we have summarized the key coding considerations for radiology practices billing mammography services this year. (Click here to read our complete article on the 2017 coding changes impacting diagnostic and intervential radiology.)

Categories: radiology reimbursement, radiology coding, breast imaging

How the 2017 Coding Changes Will Affect Diagnostic and Interventional Radiology Practices

The annual cycle of revising codes in the Current Procedural Terminology (CPT)® has been completed with the issuance of the Medicare Physician Fee Schedule (MPFS) Final Rule for 2017. For diagnostic radiology, the changes this year are in mammography bundling, ultrasound screening for abdominal aortic aneurysm, and fluoroscopic guidance.  Interventional Radiology (IR) will also be subject to bundling and other rearranging of codes for certain procedures.  Finally, there are new codes that have been created to describe procedures previously unlisted, which generally will improve reimbursement for those procedures, and codes deleted from use, which will return the affected procedures to the ‘unlisted’ category.

Categories: radiology reimbursement, radiology coding, interventional radiology, IR coding, CPT codes

Why the MIPS Patient-Facing Rules are Important to Radiologists

Physicians and other Eligible Clinicians (ECs) who are participating in MIPS under the MACRA rules governing Medicare payments will face requirements that differ depending on whether they are deemed to be “patient-facing” or not.  This determination will affect the Advancing Care Information (ACI) and Improvement Activities (IA) components, but not the Quality Performance component of MIPS. In this article, we’ll break-down the key considerations for radiology practices. 

Categories: radiology reimbursement, medicare reimbursement, MIPS, MACRA

Transitioning Your Radiology Practice to MIPS: The Quality Component Updated

By now everyone involved in billing Medicare for physician services should be aware of the new Quality Payment Program (QPP) that will be in effect for payments in 2019 based on data submitted in 2017.  The proposed rules for the new system were outlined in our recent article Medicare Quality Reporting Rules are Changing.  The final regulations that will govern the new system were recently issued, and radiology practices will benefit from preparing as early as possible to capture the data they will need to report under the new system.  ­

­

­

Categories: radiology reimbursement, medicare reimbursement, MIPS, Quality Payment Program

Regulatory Changes Affecting Radiology Reimbursement in 2017

Congress has passed several Acts related to the Medicare payment system over recent years, the provisions of which will begin to take effect in 2017. These changes are embodied in the annual Medicare Physician Fee Schedule Final Rule for 2017 (MPFS) and the Hospital Outpatient Prospective Payment System Final Rule for 2017 (HOPPS).  In their initial review of the MPFS, the American College of Radiology (ACR) indicated that it “is pleased with several provisions within the rule.”

Categories: radiology reimbursement

Transitioning Your Radiology Practice to MIPS: Advancing Care Information

The Merit-Based Incentive Payment System (MIPS) is slowly being analyzed and absorbed by the medical community. This system, passed into law by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will begin to take effect for physician reimbursement in 2019 but those payment adjustments will be determined by performance in various categories for services rendered in 2017.  Regulations governing the application of this law have now been finalized and savvy radiology practices can begin to prepare to comply with the new system.

Categories: radiology reimbursement, medicare reimbursement, MIPS, MACRA, Quality Payment Program

Finalized MACRA Rules for 2017 Contain Some Good News for Radiologists

Earlier this year CMS published its proposed regulations that would implement the MACRA law to revamp the Medicare physician payment system. On October 14th, after consideration of over 4,000 comments about the proposed rules, CMS published the final rule that will govern the initial measurement period that begins January 1, 2017 for payment adjustments in 2019. 

Categories: radiology reimbursement, MIPS, MACRA, Quality Payment Program

What Radiology Practices Need to Know About the 2017 MPPR Update

Since its first appearance in the Medicare rules, the radiology community has been quarreling with CMS about the Multiple Procedure Payment Reduction (MPPR) on the professional component of certain diagnostic imaging services.  Finally, Congress has taken steps to mitigate the impact of this rule. 

Categories: radiology reimbursement, mppr

How to Choose a Radiology Revenue Cycle Management Vendor - Part 2

Our first article in this series provided a list of questions to ask when evaluating a professional services Revenue Cycle Management (RCM) vendor for your radiology practice.  If your current RCM vendor cannot answer all of them positively, it’s time to look for a new vendor.  With a large number of RCM companies available in the market, how should you decide which one to choose?

Categories: radiology reimbursement, radiology billing, radiology coding

How to Avoid Radiology Claims Denials – Medical Necessity

In our previous articles in this series, we covered the top two reasons for radiology claims denials, Patient Eligibility Problems and Lack of Proper Authorization.  The third biggest reason for insurance claims denials is failure to document the medical necessity for the exam. Let’s take a look at this issue in detail so that your radiology practice can avoid such claims denials. 

Categories: radiology reimbursement, radiology documentation, denial management

Stay up-to-date with our blog posts.

Testimonial

Learn how one radiology practice proved their value in the new healthcare  economy. Click Here.