Congress has enacted the “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA), which makes sweeping changes to the Medicare payment system. Initially conceived to put an end to the perennial struggle with the Sustainable Growth Rate (SGR) methodology, MACRA replaces the SGR with a valuation system that will minimally increment Medicare fees in the near term but which will eventually tie physicians’ fees to the quality measures they report.
Categories: medicare reimbursement, PQRS, MIPS, VBM, MACRA
The Centers for Medicare and Medicaid Services (CMS) announced that Medicare coverage for lung cancer screening using low-dose CT (LDCT) scans would become effective as of February 5, 2015. However, according to the American College of Radiology (ACR), we are likely a few months away from publication of the details needed before radiology practices can begin submitting claims to Medicare for these scans. They recommend that “physicians meeting the coverage criteria should hold all claims for low-dose CT lung cancer screening until further reimbursement instructions are released by CMS.” The article “College Addresses Lung Cancer Screening Questions” appeared in the February 13th edition of the ACR’s Advocacy in Action eNews.
Categories: radiology reimbursement, medicare reimbursement, low dose CT
The stage is set for an interesting year of coding, billing and reimbursement in radiation oncology. The CPT1 coding structure for radiation oncology services underwent significant revision in order to bundle certain services that are usually reported together and to clarify the meaning of some codes in the context of current clinical practice. In some cases this required the creation of new CPT codes to describe these services, or revision of the descriptions of existing codes in other cases. Medicare’s decision not to fully recognize these coding changes creates the potential for two different systems to be in place for 2015, and is sure to cause discrepancies between billing for Medicare and billing for other payers.
Categories: radiation oncology reimbursement, medicare reimbursement, radiation oncology coding
According to the American College of Radiology (ACR), “The technical component for more than 200 imaging procedures will be cut by up to 55 percent in the final 2015 Medicare Physician Fee Schedule (MPFS) because of a decision to remove the direct practice expense of numerous film inputs that affected their reimbursement rates in favor of the cost of acquiring a desktop computer.” The decreased reimbursement is sizable for such procedures as myelography, CTA and a variety of ultrasound studies. The ACR’s analysis was released in their recent eNews article Analog to Digital Conversion to Cost Radiologists. The article includes helpful impact tables showing the specific change in radiology reimbursement rates between 2014 and 2015 for each CPT code.
The changes cited by the ACR are the result of Medicare’s attempt to recognize that most practices today use digital PACS technology rather than film. They removed the costs associated with film production and storage, but replaced those costs with only the value of $2,501 to represent a typical radiology reading station. No recognition was given to the overall cost of installing and maintaining the central PACS hardware and software. The ACR reports that, as an example, CPT 76377 (3D Post-processing of tomographic modality) receives a 45.7% reduction for film-based costs offset by a gain of only 1.7% when the desktop computer is substituted.
Categories: radiology reimbursement, radiology coding, medicare reimbursement, MPFS
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
Physicians’ Medicare reimbursement in the coming years will be impacted by their participation in CMS quality programs in 2014. Quality reporting programs such as PQRS, Meaningful Use and the new Value-Based Modification Program have allowed physicians to earn incentives for compliance with their requirements, but beginning in 2015 that carrot will become a stick. Medicare will apply penalties that reduce reimbursement for physicians that are eligible but do not participate in the programs. Payment reductions for 2015 have already been determined by participation in 2013, but there’s still an opportunity to take steps in 2014 to avoid a reduction in 2016 payments.
Categories: radiology reimbursement, physician reimbursement, regulatory, medicare reimbursement, medical billing
On April 1st, President Obama signed into law the Protecting Access to Medicare Act of 2014 that delays for 12 months a permanent repeal of the SGR and averts a 24% Medicare physician pay cut that was scheduled to begin April 1st. The bill also extends the 0.5% provider update until March 31st, 2015. Somewhat unexpectedly, the bill also delays ICD-10 implementation until at least October 1, 2015.
Categories: radiology reimbursement, physician reimbursement, medicare reimbursement
When the dust finally settled, we could see how the 2014 Medicare Physician Fee Schedule (MPFS) would impact radiology reimbursement, and results were mixed. Hospital-based services came out ahead while imaging centers generally took a big hit. Due to the many factors that contribute to the calculation of the final fee schedule, a weighted analysis will help you determine the actual impact on your practice.
Categories: radiology reimbursement, radiology billing, regulatory, medicare reimbursement
In recent years, the Centers for Medicare and Medicaid Services (CMS) has broadened its use of the Multiple Procedure Payment Reduction (MPPR) methodology to reduce Medicare payments to physicians, but there may be situations where your practice can justify avoiding this payment reduction.
Categories: radiology reimbursement, radiology billing, physician reimbursement, regulatory, medicare reimbursement
