Radiologists concerned with maximizing practice revenue in 2015 would do well to understand the nuances of new coding changes that can impact reimbursements. The majority of coding changes for 2015 involve either bundling two codes into one when those codes are most often reported in combination or the creation of new codes to clarify their usage. The resulting impact on an individual practice’s overall payment levels should be minimal but will depend on its actual procedure mix. One major item of note is that Medicare will begin to provide reimbursement for Digital Breast Tomosynthesis (DBT, sometimes referred to as 3D Mammography) beginning in 2015 in the form of a code to be added-on to digital screening and diagnostic mammography services, although reimbursement from commercial payers is not guaranteed.
Categories:
radiology reimbursement,
radiology coding
The Medicare Physician Fee Schedule (MPFS) for 2015 sets the allowed fees for radiation therapy centers at a 1% increase, while radiation oncology professional services will remain unchanged. The Centers for Medicare and Medicaid Services (CMS) had originally proposed drastic cuts in both the professional and technical components but instead elected to defer any decision on assumptions related to major practice expense categories while additional data is gathered.
Categories:
radiation oncology coding,
MPFS
Medicare’s Physician Fee Schedule (MPFS) for 2015 contains relatively few changes that will impact payments to radiology practices next year. By revising some of the assumptions that go into the setting of the Relative Value Units (RVU), the allowed fees for diagnostic radiology professional services will decrease by 1% and imaging centers will see a 2% reduction, while interventional radiology and nuclear medicine services will remain unchanged.
Interventional Radiology Meets Radiation Oncology – The y-90 Story
When a physician is performing an interventional procedure valued in the range of $4,000 – $6,000 for the professional component, attention to thorough and accurate documentation is a requirement for maximal reimbursement. Each case presents its own individual set of circumstances and a well-constructed operative report will tell the story of the case step-by-step. Each artery or branch into which a catheter is placed for diagnostic imaging or intervention is assigned a separate CPT code, and so the operative report must describe with specificity each catheter placement. When these descriptions are in a logical, sequential order, certified coders say that this allows them to better understand every aspect of the case so they can then accurately identify and apply up to 45 CPT codes to maximize reimbursement for it. A descriptive evaluation of each artery supports payment of the codes that are submitted for reimbursement.
Categories:
radiology reimbursement,
radiology billing,
physician reimbursement,
radioembolization,
interventional radiology,
nuclear medicine,
y-90
Four new HCPCS modifiers will be available for use beginning in 2015, according to a recent announcement by the Centers for Medicare and Medicaid Services (CMS). Known collectively as the –X{EPSU} Modifiers, they will be used to define specific subsets of the CPT Modifier -59 for a “Distinct Procedural Service”. The new modifiers are intended to offer more precise coding options that will allow practices to avoid potential payment delays, audits and reviews associated with modifier -59. CMS says that -59 is the most widely used modifier, covering a wide variety of circumstances such as to identify different encounters, different anatomic sites and distinct services. Because modifier -59 is so broadly defined, it is often used incorrectly and inappropriately.
Categories:
radiology billing,
medicare,
radiology coding,
medicare reimbursement,
modifier -59,
mppr,
X{EPSU} Modifiers,
cms
As private insurance payers begin adopting the Multiple Procedure Payment Reduction (MPPR) methodology that was implemented by Medicare several years ago, practices that are not ready could face a revenue loss of 25% or more for some services. Of specific interest to radiologists is United Healthcare, which announced in its May 2014 Network Bulletin that it would be expanding its MPPR to the professional component of imaging services in alignment with Medicare’s policy. This change will apply to United Healthcare’s Commercial and Community Plan. Originally the policy was to take effect in the third quarter of 2014 but under pressure from radiology advocacy organizations, United has now reported that implementation of the policy will be delayed until the fourth quarter of 2014. This brief reprieve provides radiology practices with an opportunity to lessen this detrimental impact on their revenue by improving their current processing methodologies before these changes take place.
Categories:
radiology reimbursement,
physician reimbursement,
radiology coding,
revenue cycle management
The Centers for Medicare and Medicaid Services (CMS) said unequivocally that October 1, 2014 would be the date for mandatory implementation of the ICD-10 coding system and that there would be no further delays. CMS was overruled, however, with the signing of the Protecting Access to Medicare Act of 2014 (PAMA) on April 1, 2014, which directed that CMS could not adopt ICD-10 any earlier than October 1, 2015. Now that CMS has confirmed this revised start date in the Federal Register, radiology practices should not delay their preparations for the transition. Here are four steps your radiology practice can take to keep moving ahead with plans to be ready for ICD-10.
Categories:
radiology documentation,
radiology coding,
icd-10
HAP was recently named as the top medical coding company in this article by Medical Coding and Billing Online, a site dedicated to helping students explore education opportunities within the industry. In thanking them for this recognition, we also want to take the opportunity to recognize and thank our team of coding professionals for the excellence that they deliver to our clients on a daily basis.
Categories:
radiology coding,
icd-10,
revenue cycle management
Physicians’ Medicare reimbursement in the coming years will be impacted by their participation in CMS quality programs in 2014. Quality reporting programs such as PQRS, Meaningful Use and the new Value-Based Modification Program have allowed physicians to earn incentives for compliance with their requirements, but beginning in 2015 that carrot will become a stick. Medicare will apply penalties that reduce reimbursement for physicians that are eligible but do not participate in the programs. Payment reductions for 2015 have already been determined by participation in 2013, but there’s still an opportunity to take steps in 2014 to avoid a reduction in 2016 payments.
Categories:
radiology reimbursement,
physician reimbursement,
regulatory,
medicare reimbursement,
medical billing
On April 1st, President Obama signed into law the Protecting Access to Medicare Act of 2014 that delays for 12 months a permanent repeal of the SGR and averts a 24% Medicare physician pay cut that was scheduled to begin April 1st. The bill also extends the 0.5% provider update until March 31st, 2015. Somewhat unexpectedly, the bill also delays ICD-10 implementation until at least October 1, 2015.
Categories:
radiology reimbursement,
physician reimbursement,
medicare reimbursement
