HAP Radiology Billing and Coding Blog

The Medicare reimbursement rates for 2025 remain unchanged as a result of the Continuing Resolution (CR) passed by Congress and signed on March 15. Thus, the downward spiral of Medicare reimbursement continues with physicians receiving nominally 2.83% less this year than in 2024. Radiology practices will see somewhat different results depending on their practice pattern, as we reported in our recent article analyzing the real impact of the Medicare Physician Fee Schedule (MPFS). We calculate that the Professional Component reimbursement would decrease 2.16%, while global reimbursement at an imaging center would decrease by 3.55%, both on a weighted-average basis.

Every business in the country has to evaluate its obligation to comply with the Corporate Transparency Act (CTA) by December 31, 2024. The CTA was enacted as part of the Federal Anti-Money Laundering Act of 2020, and the regulations became effective on January 1, 2024. Many practices may already have complied with the law by either submitting the required information or by determining that they are exempt from filing. Failure to comply may invoke civil penalties of $591 per day along with criminal penalties of two years in prison and a $10,000 fine.

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.

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. 

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. 

The 2020 annual update to the ICD-10-CM^[i] system used in medical insurance claim billing became effective on October 1, 2019.  Twenty-one (21) codes were deleted, thirty (30) codes were revised and 273 new codes were added.  The good news for radiologists is that relatively few of these changes will affect your work. 

Radiologists are most likely not paying much attention to the Merit-based Incentive Payment System (MIPS) Cost category because no specific action is needed to report data, and usually radiology groups have little control over the cost attributed to a patient.  The Centers for Medicare and Medicaid Services (CMS) has released a new MIPS resource on the Cost performance category that provides good information on this aspect of the MIPS scoring.  This affords a good opportunity to review the Cost category and better understand its potential impact on your practice.

There was a time when word-of-mouth from friends and family was enough to inform our decisions, but today advice from the internet has taken precedence over recommendations from those we know personally – and this is especially true in healthcare. Patients are turning to the internet to research physicians, practices, and procedures before they even call the office to make an appointment. Individuals seeking care are more likely to choose physicians with high ratings and positive reviews over physicians with a less-than-stellar online presence.  Physicians need to be serious about their online reputation and take the necessary steps to ensure it is positive.

Earlier in March, we got the chance to sit down with Ted Burnes, Director of RADPAC (Radiology Political Action Committee) and Political Education at the American College of Radiology (ACR).  Mr. Burnes is a native of the Philadelphia region and is a regular speaker at national Radiology Business Management Association (RBMA) and other radiology society meetings. His knowledge and passion for legislative updates and how they relate to the practice of radiology is a great resource that we are excited to share with our extensive readership.

Undoubtedly you have heard the phrase, “consumerism in healthcare” but is that something that we really want, as practice administrators, as hospitalists, as physicians? Because with true consumerism, healthcare delivery will shift to a true retail business,  manifested amidst quality, price and location shopping. Within radiology and other healthcare specialties, there is now greater transparency including widespread utilization of pre-service price estimators and physician quality scores published on Medicare’s Physician Compare website,  vitals.com and zocdoc.com, among others.  However, a potentially more hidden precept of the retail business that is forthcoming is the patient refund.