We covered the major points of the 2025 Medicare Physician Fee Schedule (MPFS) Proposed Rule when it came out in July, but while we’re waiting for the Final Rule to be published later in the year let’s look at another provision in the MPFS that we’ve been watching – the locality-specific payment adjustment known as the Geographic Practice Cost Index (GPCI).
Categories: medicare reimbursement, MPFS, Medicare Physician Fee Schedule
Ever since it became effective at the beginning of 2022, the No Surprises Act (NSA) has been the subject of legal challenges from the medical provider community. In particular, legal action was filed by the Texas Medical Association, et al (TMA), to challenge the Independent Dispute Resolution (IDR) methodology, which is viewed as more favorable to insurance claims payers and grossly unfair to physicians.
Categories: radiology, No Surprises Act
Practices that reported under the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program (QPP) for 2023 can now get their performance score and find out how it will impact their Medicare reimbursement in 2025. The first step is to sign in to the QPP website to get your own practice’s results and review it for any discrepancies. The Centers for Medicare and Medicaid Services (CMS) has released the 2023 MIPS Performance Feedback FAQ’s as a guide to learning more about your practice’s performance.
Categories: MIPS, Quality Payment Program, MIPS participation, radiology, QPP
The Centers for Medicare and Medicaid Services (CMS) has issued its proposal for payments in 2025 under the Physician Fee Schedule (PFS), and it contains an across-the-board 2.8% cut from the current 2024 payment rate. This reduction in payments continues a trend that has seen the Medicare fee schedule reduced nearly 10% over the past 10 years. Last year’s proposed rule (for 2024) contained a 3.36% cut that ended up being a 1.77% cut after Congressional intervention in March, and it is possible that similar action will occur again. The Conversion Factor (CF) in the 2025 Proposed Rule is $32.3562, compared with the $33.2875 currently in use.
Categories: medicare reimbursement, interventional radiology, radiology, Medicare Physician Fee Schedule
The rules and requirements for success in the Medicare Quality Payment Program (QPP) are ever-changing, and it seems like each year brings a new challenge for practices to avoid a payment penalty or, hopefully, to earn a payment bonus. Most recently, CMS announced that the 2023 data submission deadline would be extended until April 15, 2024, due to the cyberattack at Change Healthcare in February, and that practices affected by the cyberattack could apply for an Extreme and Uncontrollable Circumstances (EUC) Exception. The EUC exception allows the applicant to request reweighting of any or all of the performance categories under the Merit-Based Incentive Payment System (MIPS).
Categories: MIPS, MIPS participation, radiology, QPP
The importance of accurate and complete coding cannot be overemphasized for any area of radiology, but the complexity of interventional radiology (IR) coding makes it even more critical for optimal reimbursement. The prerequisite for complete coding is thorough documentation that includes all of the required elements, along with a coding team that is highly trained in IR.
Categories: radiology documentation, interventional radiology, IR coding, interventional radiology billing
At the April 14 – 17 Radiology Business Management Association (RBMA) PaRADigm Conference in Las Vegas, Rebecca Farrington and Sandy Coffta presented Positioning Your Radiology Group For Success. Their talk was a dive into a captivating exploration of real-world case studies from radiology groups that rode the waves of change. Whether the group soared to success or stumbled along the way, there's a story behind every strategic decision. Rebecca and Sandy unveiled the common pitfalls, the surprise twists, and the must-focus areas for crafting a winning strategy, including the informed choices that helped the groups navigate the intricacies of strategic planning.
Categories: interventional radiology, radiology
The ability to have radiologists work at locations remote from the patient exam site can be a great boon to efficiency and turnaround time. This practice has become more prevalent with the advent of faster network connections, and it has increased significantly since the COVID-19 pandemic when more people began working off-site. Compliant billing for remote reading services is not always as straightforward as normal on-site billing, and radiology practices must be aware of the requirements of each payer, most especially those of Medicare and other government programs.
Categories: medicare, radiology, remote reading, place of service
With passage of the Consolidated Appropriations Act, 2024 (CAA 24), we finally learned the rates physicians will be paid for Medicare services during the remainder of 2024. Effective when it was signed by the President on March 9, 2024 the CAA 24 contained several provisions that benefitted physician reimbursement:
Categories: medicare reimbursement, MPFS, radiology, Medicare Physician Fee Schedule
We pay a lot of attention to government regulation in healthcare, especially the Medicare Physician Fee Schedule (MPFS) that influences reimbursement not only from Medicare, but also from other payers since many commercial contracts are tied to the MPFS. Although it is the object of most focus, the Centers for Medicare and Medicaid Services (CMS) is not the only agency that regulates healthcare.
Categories: MPFS, radiology, appropriate use criteria, information blocking, No Surprises Act
