HAP Radiology Billing and Coding Blog

New Jersey is the latest state to pass legislation that will affect the amount a radiology practice can collect from patients whose insurance is not accepted by the practice.  While an imaging center would be careful to work with their patients in advance of providing services, the hospital setting does not always afford that opportunity.  It is imperative that you know the laws not only in the state(s) where you practice but also to keep abreast of federal regulations that might impact your billing and collections.

CMS, the Centers for Medicare and Medicaid Services, is constantly on the lookout for procedure codes that it feels do not reflect the current cost or complexity of practice in their valuation.  The annual Medicare Physician Fee Schedule (MPFS) rule modifies many codes with varying degrees of impact to radiology practices. 

With the 2017 MIPS reporting year behind us, we now know that practices that achieved the highest possible Final Score of 100 points will receive 2.02% more Medicare reimbursement than the basic fee schedule for 2019.  This increase is compared with the possibility of a 4% payment reduction for practices that did nothing, and a zero-percent adjustment for practices that did the minimum amount of reporting.  In between the minimum level and a perfect score, the fee schedule positive adjustment varies on a sliding scale computed by Medicare.

In today’s healthcare landscape, patients are paying more out-of-pocket for services than ever before. The numbers of people with high deductible health plans and those who are uninsured have risen; often leaving patients with large medical bills and providers struggling to collect the money they are owed.

The Centers for Medicare and Medicaid Services (CMS) has combined its rule making for both the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP) into one document for its 2019 proposal.  This article will summarize the elements of each area that will most affect radiology practices if they are ultimately finalized and become law later this year. 

Healthcare reform is forcing ongoing risk vs. reward debates that seek consensus on the ideal balance of cost expenditure and patient care quality. As a prime example: the issue of if and how to best handle patients with incidental imaging findings receives continued scrutiny. This Reuters article summarizing a recent study in the British Medical Journal (BMJ) highlights the complexities inherent to developing standards of care for the major types of incidentalomas. It also reveals key insights that can be used for the benefit of radiology practices and patients alike.  

Recently reported developments in federal health care policy could change the direction radiologists are taking to maintain maximum Medicare reimbursement. 

Consumerism in the world of healthcare means that patients are taking a more active interest in the cost and quality of the services they receive.  They have been forced to foot the bill for an ever-larger share of the total cost, and they want to make sure they are receiving the highest quality for their expenditure.  We have written before about the impact of today’s high-deductible health insurance plans, and thus far the slow dissolution of the Affordable Care Act is not causing employers or insurers to back down from those high deductibles. 

The Medicare rules for billing services performed in off-campus Hospital Outpatient Departments (HOPD) changed with the passage of the Bipartisan Budget Act of 2015 (BBA), with the result that ownership of imaging centers by hospitals is becoming less attractive than it once was.  HOPDs operating prior to November 2, 2015 are exempted from this change, but there might be other good reasons for hospitals to consider making alternative arrangements. 

In an article published in the online Journal of the American College of Radiology¹, authors from Duke University Medical Center Department of Radiology present a study conducted to demonstrate the variability and complexity of radiologists’ dictated notes. The authors chose to analyze the language used to describe normal thyroid glands in chest CT reports as a “surrogate for the broader readability of radiology reports”. In a sample of nearly seven thousand non-contrast chest CT reports, the researchers found 342 unique sentences or phrases describing a normal thyroid gland. Furthermore, linguistic analysis suggested that descriptors for a normal thyroid gland require an advanced college-level education for comprehension. This text is well above the national average health literacy level and results in reports that are difficult for patients to understand.²