HAP Radiology Billing and Coding Blog

Regulatory Issues Facing Radiology Groups In 2024 on February 23, 2024

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

Coding Changes That Will Impact Diagnostic & Interventional Radiology Practices in 2024 on January 29, 2024

The annual update to the Current Procedural Terminology[1] (CPT)® for 2024 has 230 new codes, 70 revised codes, and 49 deleted codes. In addition, there are 395 new diagnosis codes contained in the ICD-10-CM[2] update, about one-third of them describing new ways to capture accidents and injuries. Although relatively few of these changes will impact radiology practices, it’s essential to know what they are and adjust your practice systems accordingly.

Categories: radiology coding, icd-10, interventional radiology, IR coding, CPT codes, diagnostic radiology

2024 Medicare Physician Fee Schedule Final Rule Includes Payment Reductions for Radiology on November 8, 2023

The Centers for Medicare and Medicaid Services (CMS) announced its Medicare Physician Fee Schedule (MPFS) Final Rule for 2024, including provisions for both Medicare reimbursement and the Quality Payment Program (QPP).

Categories: interventional radiology, cms, MPFS, radiology, QPP, diagnostic radiology

How Medicaid Unwinding Could Impact Radiology Practices on October 12, 2023

During the COVID-19 Public Health Emergency, states were required to maintain enrollment of nearly all Medicaid enrollees as a condition of receiving a temporary 6.2 percentage point Federal Medical Assistance Percentage (FMAP) increase under the Families First Coronavirus Response Act (FFCRA). There was significant growth of national Medicaid enrollment figures due to this continuous Medicaid enrollment requirement, coupled with additional incentives for states to implement Medicaid expansion. The Kaiser Family Foundation estimates that the combination of Medicaid and CHIP (Children’s Health Insurance Program) enrollment has increased by over 23 million people between February 2020 and March 2023. However, when that continuous enrollment condition ended on March 31, 2023, Medicaid enrollment numbers started to decline. States had to resume normal operations, including restarting full Medicaid eligibility renewals and terminations of coverage for individuals who are no longer eligible. The full process could take up to a year, with the earliest removals from coverage having begun in April 2023.

Categories: cms, radiology, medicaid

Why Support for H.R. 2474 Is Important to Your Radiology Practice on September 21, 2023

The Strengthening Medicare for Patients and Providers Act (H.R. 2474) would modify the way the Medicare Physician Fee Schedule (MPFS) is calculated and adjusted each year. The basic system of determining Relative Value Units (RVU) would not change, but the annual adjustment of the Conversion Factor (CF) would more closely reflect the actual economic factors that affect physicians’ practices.

Categories: MPFS, RVU

Radiology Practices Struggle to Avoid Penalties in the Medicare Quality Payment Program on August 31, 2023

For many radiology practices, the idea of a positive payment adjustment for participation in the Medicare Quality Payment Program (QPP) has been lost. Several factors have combined over the past few years to change the goal for radiology practices – it is now ‘penalty avoidance’ rather than a reward for reporting quality metrics. As we outlined in our recent review of the Medicare 2024 Physician Fee Schedule Proposed Rule, the QPP requirements for successful participation are going to become even stricter.

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

Medicare Proposed Rule For 2024 Will Not Improve Radiology Reimbursement on July 27, 2023

The Centers for Medicare and Medicaid Services (CMS) announced its proposed Medicare Physician Fee Schedule (MPFS) rules for 2024, including provisions for the Quality Payment Program (QPP). While not a done deal until the final rule is issued toward the end of the year, the Proposed Rule gives an indication of where CMS is headed with regard to payment policy. In recent history, even the Final Rule isn’t final because Congress has had to intervene to stave off significant reimbursement reductions. Here are the highlights of the 2024 Proposed Rule.

Categories: medicare, medicare reimbursement, radiology, QPP, Medicare Physician Fee Schedule

Maximize Duplex Doppler Ultrasound Documentation & Reimbursement on July 6, 2023

Complete documentation of any radiology procedure is the key to appropriate reimbursement. This is especially true for venous duplex Doppler ultrasound exams, where including fewer than the required number of elements for a complete procedure will result in reimbursement for a limited study.

Categories: radiology reimbursement, radiology documentation, ultrasound

You Can Help Improve the Medicare Physician Fee Schedule on June 5, 2023

Reimbursement under the Medicare Physician Fee Schedule (MPFS) has been consistently reduced for as many years as most of us can remember. Most recently, the 2023 payment rate was cut another 2.08% from the 2022 level, leaving the fee schedule 7.6% lower than it was in 1998 and 11.0% lower than it was in 2008.

Categories: MPFS, radiology

How Can Radiology Networking Improve Your Practice? on March 10, 2023

A large metropolitan-area radiology group covers several departments within a hospital system. They have on-site staff daily at each location to handle all modalities, including sub-specialists to be sure pediatric, neuro, and body imaging are handled with the right expertise. They find that on some days a particular department is overloaded, while on the same day another department is slow. The subspecialists don’t always have enough work in their area to keep them busy. Lately, trying to hire enough hands in the tight radiology job market has become more and more difficult as well as costly. Unfortunately, the various hospitals do not all employ the same PACS even though they’re part of the same parent system. This group’s situation is not unique.

Categories: radiology

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