HAP Radiology Billing and Coding Blog

Get Feedback on Your 2019 Quality Payment Program Performance

Quality Payment Program (QPP) participants can now obtain information about whether their practice will receive a positive, negative, or neutral Medicare fee schedule adjustment in 2021 based on the 2019 data they submitted. The Centers for Medicare and Medicaid Services (CMS) announced that clinicians who participated in the Merit-based Incentive Payment System (MIPS) in 2019 can access their performance feedback by logging in to the Quality Payment Program website

Categories: radiology reimbursement, physician reimbursement, cms, Quality Payment Program, QPP, quality measures

Medicare Delays Recoupment of Advances

One of the fastest and easiest sources of emergency funding available to practices at the outset of the COVID-19 pandemic was the Medicare Accelerated and Advanced Payment Program.  As we recently reported, the initial timetable called for repayment of those advances to begin 120 days after the advance was made. Repayment was to be accomplished through reduction of Medicare reimbursements otherwise payable to the practice currently, until the full amount of the advance was repaid.

Categories: medicare, medicare reimbursement, cms, radiology, COVID-19

Medicare Proposed Major Cut in Radiology Reimbursement for 2021

The Centers for Medicare and Medicaid Services (CMS) has released their annual proposal for changes to the Medicare payment system for the coming year. The Medicare Physician Fee Schedule (MPFS) Proposed Rule contains not only proposed adjustments to Medicare reimbursement but also proposed changes to the Quality Payment Program (QPP) for 2021 and beyond.

Categories: radiology reimbursement, medicare, medicare reimbursement, cms, radiology

Medicare Announces Prior Authorization Requirement

Radiologists who perform venous ablation in a hospital outpatient department are now required to obtain prior authorization before performing such services on Medicare patients.  This new requirement became effective for services performed on or after July 1, 2020, and physicians were notified by letters from the Centers for Medicare and Medicaid Services (CMS) late in June.  The prior authorization requirement was included in the 2020 Hospital Outpatient Prospective Payment System (HOPPS) Final Rule, and encompasses the following procedures that might be performed by interventional radiologists:

Categories: radiology reimbursement, radiology billing, interventional radiology, cms, interventional radiology billing

Quality Payment Program Modified Due to COVID-19 Outbreak

The Centers for Medicare and Medicaid Services (CMS) announced that they have adjusted certain aspects of the Quality Payment Program (QPP) in response the Public Health Emergency (PHE) caused by the COVID-19 coronavirus outbreak.  CMS has extended the deadline for reporting 2019 Merit-based Incentive Payment System (MIPS) data and has relaxed the criteria for avoiding a penalty in 2021 based on submission of 2019 data.

Categories: cms, MIPS, Quality Payment Program, MIPS participation, QPP

Relaxed Telehealth Regulations for Radiologists in the Wake of COVID-19

This article was updated on
April 14, 2020. 


Medicare has temporarily opened up the ability for physicians to provide medical care to patients without the need for them to be in the same physical location.  Beginning  March 2020 and continuing through the end of the current COVID-19 Public Health Emergency (PHE), the rules for providing telehealth services have been relaxed.  Is there any opportunity for radiologists to use telemedicine in their practice? 

Categories: medicare, medicare reimbursement, cms, teleradiology billing, teleradiology

Quality Payment Program Update for 2020

Participation in the Quality Payment Program (QPP) means that you always have several years’ information in play at one time.  The score you earned from submitting 2018 data will now be impacting your Medicare reimbursement in 2020; you have just completed your 2019 performance and it’s time to submit your data; and finally, you now have to begin your 2020 performance year.

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

What the January 2020 Update to the Medicare AUC/CDS Mandate Means for Radiologists

It’s a cold January here in the northeastern US, so it’s a good time to heat up plans to comply with the Medicare AUC Mandate!  We have entered the official Educational and Operations Testing Period of 2020, which means that Medicare is ready to accept the Appropriate Use Criteria (AUC) modifiers and G-codes on claims now being submitted.  Let’s first review what this Medicare mandate means and then make plans to get it operational in your practice.

Categories: radiology reimbursement, medicare, cms, CDS, AUC

How the Medicare Final Rule For 2020 Will Affect Radiologists

The Centers for Medicare and Medicaid Services (CMS) has released the annual changes to the Medicare Physician Fee Schedule (MPFS) in its Final Rule that contains not only adjustments to Medicare reimbursement but also revisions to the Quality Payment Program (QPP) for 2020 and beyond.   The MPFS Final Rule does not contain very many significant changes for the coming year, especially for radiology, but one of its provisions will have a far-reaching effect on radiology beginning in 2021. 

Categories: medicare, medicare reimbursement, cms, MPFS, radiology, QPP, quality measures

Get Feedback on Your 2018 Quality Payment Program Performance

The Centers for Medicare and Medicaid Services (CMS) announced that clinicians who participated in the Merit-based Incentive Payment System (MIPS) in 2018 can access their 2018 performance feedback by logging in to the Quality Payment Program website.   The information should confirm whether you or your practice will receive a positive, negative, or neutral Medicare fee schedule adjustment in 2020 based on the 2018 results.  According to a posting on the CMS website, 98% of eligible clinicians participated in MIPS for 2018, up from 95% in 2017, and 97% will receive a positive payment adjustment by virtue of exceeding the 15-point performance threshold. 

Categories: cms, MIPS, Quality Payment Program, MIPS participation, QPP

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