HAP Radiology Billing and Coding Blog

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

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

How the 2018 Coding Changes Will Affect Radiology Practices

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

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, radiation oncology reimbursement, medicare, radiology billing

CMS to Deny Imaging Claims without Proper Order Information

CMS, the Centers for Medicare and Medicaid Services, has announced that it will begin full enforcement of rules concerning physician orders that have been in place since 2009. These rules will impact radiology billing. Beginning January 6, 2014, claims submitted for imaging services will be denied if they do not accurately report the name and NPI number of the ordering/referring provider.

Categories: radiology reimbursement, regulatory, medicare, radiology billing

Sequester Cuts Medicare Physician Reimbursement beginning April 1st

Physicians will begin to see their Medicare payments cut by 2% for services rendered beginning April 1st as the federal budget sequester takes effect. Their patients will still be responsible for co-insurance and deductibles at the same, pre-sequester level. For unassigned claims, reimbursements to beneficiaries would be subject to the 2% sequester reduction just like payments to physicians on assigned claims.

Categories: regulatory, medicare, physician reimbursement

Medicare Place of Service - Logistical Problems for Radiology Billing

Radiology practices using teleradiology – servicing both hospitals and imaging centers – will have to consider whether they need to make any changes to their billing and reporting due to Medicare’s final Place of Service rules. CMS, the Centers for Medicare and Medicaid Services, has long been trying to establish rules for reporting the location of physician services. However, the rules have been delayed by questions and logistical problems that have been raised by those affected, primarily in the radiology community. Although many questions remain, CMS has issued what it considers to be its final set of rules, and they will become effective April 1, 2013. Practices should take a look at their service locations to see if they are operating in more than one payment locality and whether physicians are reading in locations other than where the patient was seen. If so, there is work to be done to prepare for the changes needed to submit radiology billing claims under the Medicare Physician Fee Schedule. 

Categories: radiology reimbursement, radiology billing, regulatory, medicare

Regulatory Changes Affecting Radiology and Radiation Oncology in 2013

Even though Congress has averted the across-the-board SGR fee schedule cut (26.5%) for another year, radiologists will take another 3% cut this year. This, in addition to expanding the PC MPPR of 25% for CT, MRI and ultrasound imaging to include other members of the group practice, means that there is no good news for radiologists this year.

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

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