HAP Radiology Billing and Coding Blog

First Look at the New Medicare Rules for 2020

The Centers for Medicare and Medicaid Services (CMS) released their annual proposal for changes to the Medicare payment system for the coming year, and they also released new information about the existing mandate for the use of Clinical Decision Support (CDS) beginning in 2020.  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 2020 and beyond.

Categories: medicare, medicare reimbursement, MPFS, Quality Payment Program, radiology, QPP

Update on Interventional Radiology Coding and Billing

Proper coding of physician services is essential to efficient billing and the optimization of reimbursement from payers, including commercial and governmental entities.  The CPT® codes issued by the American Medical Association (AMA) to describe physician procedures are supposed to be recognized as standards, but in practice they are not accepted equally by all payers.  One example is CPT codes in the range 99241-99255 that describe consultation services.  These are most often used by interventional radiologists, as described in our article Coding and Billing Considerations in Interventional Radiology.

Categories: radiology billing, medicare, medicare reimbursement, interventional radiology, radiology, interventional radiology billing

Appropriate Use Criteria Revisions by the American College of Radiology

Medicare’s requirement that ordering physicians begin to use clinical decision support mechanisms (CDSM) when ordering certain advanced imaging examinations will take effect next year, and most radiology practices are gearing up to be ready.  Any CDSM will require a set of rules, or Appropriate Use Criteria (AUC), that will guide the decision-making process. 

Categories: medicare, cms, CDS, AUC

Coding Changes That Will Impact Radiology Practices In 2019

Each year there are revisions of Current Procedural Terminology[i] (CPT)® that will impact the way radiology practices code their procedures and, ultimately, how they are reimbursed for those procedures.  The majority of CPT code changes in radiology for 2019 are for Interventional Radiology procedures.  Those that pertain to diagnostic radiology are in ultrasound, MRI, and nuclear medicine.  We’ll cover the diagnostic codes first, and then go into detail on the interventional coding changes.

Categories: medicare, medicare reimbursement, interventional radiology, MPFS, CPT codes, radiology, diagnostic radiology

What the MPFS Proposed Rule for 2019 Means for Radiologists

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. 

Categories: medicare, medicare reimbursement, MPFS, Quality Payment Program, radiology, QPP

The Future for Radiologists in the QPP

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

Categories: radiology reimbursement, medicare, medicare reimbursement, Quality Payment Program, radiology, QPP

How the 2018 Coding Changes Will Affect Radiology Practices

Click here to read our 2019 radiology code changes article. 

 

The recently issued Medicare Physician Fee Schedule (MPFS) Final Rule for 2018 tells us which of the revisions to the Current Procedural Terminology[i] (CPT)® have been adopted for use in the Medicare system, and how Medicare values those codes.  The diagnostic radiology changes are fairly straightforward, but the Interventional Radiology (IR) coding for Endovascular Repair has been drastically altered with 20 new or revised codes. 

Categories: medicare, medicare reimbursement, interventional radiology, MPFS, CPT codes, radiology

Regulatory Changes Affecting Radiology Reimbursement in 2018

The regulations that will affect Medicare reimbursement for physician practices in 2018 have been released.  They include the Medicare Physician Fee Schedule Final Rule  (MPFS), the hospital Outpatient Prospective Payment System Final Rule (OPPS), and the Quality Payment Program Final Rule (QPP). 

Categories: medicare, medicare reimbursement, MPFS, QPP, OPPS

Is Your Radiology Practice Ready for the New HCPCS Modifiers?

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

Radiology and Radiation Oncology: Regulatory Changes for 2014

The Medicare Physician Fee Schedule (MPFS) contains lower reimbursement in 2014 for diagnostic imaging and interventional radiology due to revisions adopted by the Centers for Medicare and Medicaid Services (CMS) in the annual Medicare rules update published in December. Radiation oncology practices will see a slight increase in the fee schedule while freestanding radiation therapy centers are facing considerable reductions. Meanwhile, Congress took some action to defer even larger cuts but continues to leave the medical community uncertain of future payment rates for physician services.

Categories: radiology reimbursement, radiology billing, medicare, radiation oncology reimbursement

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