HAP Radiology Billing and Coding Blog

The Medicare Final Rule Confirms Big Payment Reduction For 2023 on November 15, 2022

When the 2023 Medicare Physician Fee Schedule (MPFS) was proposed earlier this year it projected a 4.42% cut to the conversion factor (CF), with radiology facing cuts of between 3 – 4% depending on subspecialty. The final rule moves the cut even deeper, with the 2023 CF set 4.47% lower than the 2022 CF.

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

When Will Programs and Policies Enacted During the Pandemic End? on May 10, 2022

With our first article posted in March 2020, we began a series designed to help you stay abreast of the many regulatory changes and funding opportunities that would help you get through the COVID-19 Public Health Emergency (PHE). The PHE is now scheduled to end on July 15, 2022, unless it is extended for another 90 days, but regardless of exactly when the PHE ends you will need to know what to expect. Some policies will end immediately, and others will end in some number of days later.

Categories: medicare, HHS PRF, Public Health Emergency, PHE, telehealth, medicaid

Understanding The Impact of The Medicare Fee Schedule For 2022 On Your Radiology Practice on January 17, 2022

Now that the final Medicare conversion factor (CF) for 2022 of $34.6062 has been established, following passage of the Protecting Medicare and American Farmers from Sequester Cuts Act, we can analyze the real impact that radiology practices can expect this year. We reported recently that the final CF is a 0.82% reduction from the 2021 rate. However, the CF is not the only factor that affects the Medicare fee schedule. CMS annually revises the pricing of various procedure codes due to changes in practice expense, which generally affects the Technical Component (TC) more than the Professional Component (PC). Accordingly, radiologists will see a different overall result for services in a private office or imaging center than they will for hospital services.

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

Congress Responds to Lessen Medicare Cuts For 2022 on December 17, 2021

The Medicare Physician Fee Schedule (MPFS) Final Rule for 2022 contained a 3.71% decrease in the Conversion Factor (CF), as we reported in our recent review of the rule. However, after lobbying by physicians and their representative organizations, Congress passed the Protecting Medicare and American Farmers from Sequester Cuts Act (the Act) that rolls back most of that cut and boosts the fee schedule that was contained in the MPFS Final Rule by 3%. We calculate that the CF for 2022 will therefore be $34.6062 instead of $33.5983, although the exact figure has not yet been released.

Categories: medicare, medicare reimbursement, Medicare Physician Fee Schedule

More Evidence That Radiology is Not the Source of Medicare Spending Increases on September 22, 2021

It seems that diagnostic imaging and radiology are often blamed for increasing the cost of healthcare, especially Medicare costs. Not so, says a recent study that was reported in Radiology Business on August 30, 2021.

Categories: medicare, cms, radiology

An Important Deadline for Radiology Practices to Comply with the Medicare AUC/CDS Mandate on June 16, 2021

On January 1, 2022, radiology practices and hospitals that perform certain imaging services for Medicare patients will be denied payment for those services unless they submit documentation that the ordering physician has consulted a Clinical Decision Support (CDS) system. This regulation was included a few years ago in Medicare rulemaking, but its effective date has been delayed several times. As of now, there is no reason to believe it will be postponed further, so practices that have not yet taken steps to install and implement a system have a narrow window of opportunity to get ready.

Categories: medicare, medicare reimbursement, nuclear medicine, CT imaging, MRI, CDS, radiology, AUC, referring physicians, PET, 2022 payment impact

Federal Programs to Assist Radiology Practices During the Pandemic on March 30, 2021

At around this time last year we were beginning to learn about the various ways medical practices could make use of federal programs to help keep them afloat through the COVID-19 pandemic. No one knew how long it would last. As time went on, we followed the changes to those programs, the new programs that became available, and the deadlines for action. Let’s review the latest federal legislation and also where each of last year’s relief programs stands today, especially the Medicare Payment Sequester that is a developing story.

Categories: medicare, radiology, teleradiology, PPP

Understanding the Impact of The Medicare Fee Schedule for 2021 on Your Radiology Practice on January 25, 2021

When the Medicare Physician Fee Schedule (MPFS) Final Rule was published in December, it looked like radiology was facing a significant cut in Medicare reimbursement for 2021. Our article reported that professional component fees would drop 10-11% while global reimbursement would see a lesser impact. The Consolidated Appropriations Act, 2021 (CAA) rolled back those cuts at least for 2021, although the Medicare fee schedule for radiology will likely continue to be adjusted downward in the future as implementation of the revalued Evaluation and Management (E&M) services is fully phased in.

Categories: radiology reimbursement, medicare, medicare reimbursement, MPFS, radiology

How the Consolidated Appropriations Act Will Impact Radiology Practices on January 18, 2021

The “Consolidated Appropriations Act, 2021” (CAA) is a sweeping piece of legislation that provides relief to individuals and businesses impacted by the COVID-19 public health emergency. Some of the relief provisions apply to all businesses, including medical practices, but it also contains several measures that specifically apply to medical practices.

Categories: radiology reimbursement, medicare, medicare reimbursement, radiology, surprise billing, Paycheck Protection Program

Medicare Delays Recoupment of Advances on September 10, 2020

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

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