HAP Radiology Billing and Coding Blog

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

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

Radiology’s Declining Reimbursement Spans More Than A Decade on August 20, 2020

The average cut of 11% in radiology reimbursement that is proposed by the Medicare Physician Fee Schedule for 2021 (MPFS) is the continuation of a trend that spans more than a decade.

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

Medicare Proposed Major Cut in Radiology Reimbursement for 2021 on August 14, 2020

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

Relaxed Telehealth Regulations for Radiologists in the Wake of COVID-19 on March 20, 2020

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

2020 Medicare Fee Schedule Valuation Changes & Radiology Practice Impact on February 26, 2020

In the final 2020 Medicare Physician Fee Schedule (MPFS), fee increases relevant to radiology overall outnumbered decreases.  However, many of those increases were insignificant changes of less than 1%.  There were 128 Professional Component (PC) codes decreased by more than 1%, with only 76 increased, while 430 Global codes increased by more than 1% and 346 Global codes decreased.  Here are the details:

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

How the Medicare Final Rule For 2020 Will Affect Radiologists on November 15, 2019

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

First Look at the New Medicare Rules for 2020 on August 13, 2019

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

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