HAP Radiology Billing and Coding Blog

Quality Payment Program Modified Due to COVID-19 Outbreak

The Centers for Medicare and Medicaid Services (CMS) announced that they have adjusted certain aspects of the Quality Payment Program (QPP) in response the Public Health Emergency (PHE) caused by the COVID-19 coronavirus outbreak.  CMS has extended the deadline for reporting 2019 Merit-based Incentive Payment System (MIPS) data and has relaxed the criteria for avoiding a penalty in 2021 based on submission of 2019 data.

Categories: cms, MIPS, Quality Payment Program, MIPS participation, QPP

Relaxed Telehealth Regulations for Radiologists in the Wake of COVID-19

Medicare has temporarily opened up the ability for physicians to provide medical care to patients without the need for them to be in the same physical location.  Beginning on March 6, 2020 and continuing through the end of the current COVID-19 Public Health Emergency (PHE), the rules for providing telehealth services have been relaxed.  Is there any opportunity for radiologists to use telemedicine in their practice? 

Categories: medicare, medicare reimbursement, cms, teleradiology billing, teleradiology

Quality Payment Program Update for 2020

Participation in the Quality Payment Program (QPP) means that you always have several years’ information in play at one time.  The score you earned from submitting 2018 data will now be impacting your Medicare reimbursement in 2020; you have just completed your 2019 performance and it’s time to submit your data; and finally, you now have to begin your 2020 performance year.

Categories: cms, MIPS, Quality Payment Program, MIPS participation, QPP, quality measures

2020 Medicare Fee Schedule Valuation Changes & Radiology Practice Impact

In the final 2020 Medicare Physician Fee Schedule (MPFS), fee increases relevant to radiology overall outnumbered decreases.  However, many of those increases were insignificant changes of less than 1%.  There were 128 Professional Component (PC) codes decreased by more than 1%, with only 76 increased, while 430 Global codes increased by more than 1% and 346 Global codes decreased.  Here are the details:

Categories: radiology reimbursement, radiology billing, medicare reimbursement, MPFS, interventional radiology billing

What the January 2020 Update to the Medicare AUC/CDS Mandate Means for Radiologists

It’s a cold January here in the northeastern US, so it’s a good time to heat up plans to comply with the Medicare AUC Mandate!  We have entered the official Educational and Operations Testing Period of 2020, which means that Medicare is ready to accept the Appropriate Use Criteria (AUC) modifiers and G-codes on claims now being submitted.  Let’s first review what this Medicare mandate means and then make plans to get it operational in your practice.

Categories: radiology reimbursement, medicare, cms, CDS, AUC

Coding Changes That Will Impact Radiology Practices In 2020

With the new year comes the annual revision of Current Procedural Terminology[i] (CPT)® coding that practices have to be aware of.  For diagnostic radiology, the changes for 2020 are relatively few and they are concentrated in the areas of abdominal and gastrointestinal plain films, nuclear medicine procedures for tumor localization, and myocardial PET imaging.  The changes to interventional radiology coding are likewise quite limited and involve pericardial and spinal puncture procedures. 

Categories: radiology coding, IR coding, CPT codes

Get Ready for Changes to Radiology Billing in 2020

Our own Sandy Coffta, Vice President of Client Services, spoke with Aunt Minnie’s Brian Casey at the 2019 RSNA Annual Meeting in Chicago.  In the interview posted on auntminnie.com, Sandy mentioned some of the highlights that practices should be concerned about in the coming year. 

Categories: radiology reimbursement, radiology billing, radiology documentation, radiology coding, radiology

Update on Surprise Billing Legislation Across the Country

In the absence of federal regulation, states are adopting laws intended to protect patients from high out-of-pocket costs when they unexpectedly receive services from out-of-network (OON) providers.  When a patient receives an unexpected bill following such OON services the situation is known as “surprise billing.”  Not all OON billing falls into the category of “surprise billing,” however.  In many cases, patients understand that the services they are receiving are OON and they expect to pay all or part of the bill.

Categories: radiology reimbursement, radiology billing, surprise billing

How the Medicare Final Rule For 2020 Will Affect Radiologists

The Centers for Medicare and Medicaid Services (CMS) has released the annual changes to the Medicare Physician Fee Schedule (MPFS) in its Final Rule that contains not only adjustments to Medicare reimbursement but also revisions to the Quality Payment Program (QPP) for 2020 and beyond.   The MPFS Final Rule does not contain very many significant changes for the coming year, especially for radiology, but one of its provisions will have a far-reaching effect on radiology beginning in 2021. 

Categories: medicare, medicare reimbursement, cms, MPFS, radiology, QPP, quality measures

Pennsylvania’s Act 112 to Become Effective Soon

The “Patient Test Result Information Act”, or Pennsylvania Act 112 of 2018, will take full effect on December 23, 2019.  The Act was originally scheduled to begin in December 2018, but the imposition of citations and fines was delayed for one year.  During that time, many hospitals and radiology practices have implemented systems designed to help them comply with this law. 

Categories: radiology, clinical analytics, PA Act 112

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