HAP Radiology Billing and Coding Blog

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

In our recent article we explored the ways radiology groups can begin to move toward participation in Alternative Payment Models (APM*) as an option in place of working within MIPS under the Medicare QPP.  But what does APM participation mean for a radiology practice, and what should radiologists look for to begin moving in this direction? 

In radiology, like all other medical specialties, proper documentation is critical to achieving appropriate reimbursement. If the proper terminology is no used or important descriptors are omitted from the radiology report, the physician may not get paid for the services he or she performed.

There’s no doubt that Medicare’s payment for physician services is moving toward a value-based system, and many other healthcare payers are following that lead.  CMS[i] is mandated under MACRA to implement value-based payments.  So far, most radiology practices are struggling to comply with the MIPS branch of the two-pronged MACRA system but the goal of CMS is to eventually move all physicians to the other branch, Alternative Payment Models (APM). 

In a study published in the February 2018 issue of Academic Radiology, Dr. Andrew Rosenkrantz of NYU Langone Medical Center proposes that measuring physician outcomes and resource utilization requires appropriate patient risk adjustment. Using publicly available data from CMS, he and his fellow researchers compared one year of risk-adjustment scores among fifty-four physician specialties to determine the relative complexity of their attributed patient populations. The team analyzed the results for radiologists (31,175 of 549,194 total) based on a range of practice characteristics: teaching affiliations, practice size, geography, and subspecialty.

When Congress finalized the fiscal 2017 federal budget on February 9, 2018, the bill¹ contained some changes that will affect the Medicare Quality Payment Program (QPP) in the coming years. Nothing in the bill changes Medicare payment levels or the MIPS² reporting requirements for 2018. There is, however, a change that affects the 2018 performance year low-volume exclusion.

Here is a summary of the changes:

Our recent article How Radiology Practices Can Drive True Quality of Care describes how the use of clinical data can be integrated with a business process to provide benefits for both patient care and practice value.  Expanding this concept to the next level triggers the imagination – what other types of cases in the practice need follow-up within specific time periods?  Thus came the idea for the second iteration of HAP’s clinical analytics solution deployment that involved patients with implanted inferior vena cava (IVC) filters.

A recent study^[1] published by the Journal of the American College of Radiology concludes that clinicians prefer radiology reports in a more structured format over those in a “more traditional, prose style”.  This finding supports the position we at Healthcare Administrative Partners have long advocated.  Our May 2016 article points out the many benefits of structured reporting, which include easier transition to clinical decision support systems, compliance with quality reporting standards, and fewer denials from payers for questions of medical necessity or coding at the appropriate level of service.