HAP Radiology Billing and Coding Blog

Regulatory Issues Facing Radiology Groups In 2024 on February 23, 2024

We pay a lot of attention to government regulation in healthcare, especially the Medicare Physician Fee Schedule (MPFS) that influences reimbursement not only from Medicare, but also from other payers since many commercial contracts are tied to the MPFS. Although it is the object of most focus, the Centers for Medicare and Medicaid Services (CMS) is not the only agency that regulates healthcare.

Categories: MPFS, radiology, appropriate use criteria, information blocking, No Surprises Act

2024 Medicare Physician Fee Schedule Final Rule Includes Payment Reductions for Radiology on November 8, 2023

The Centers for Medicare and Medicaid Services (CMS) announced its Medicare Physician Fee Schedule (MPFS) Final Rule for 2024, including provisions for both Medicare reimbursement and the Quality Payment Program (QPP).

Categories: interventional radiology, cms, MPFS, radiology, QPP, diagnostic radiology

Why Support for H.R. 2474 Is Important to Your Radiology Practice on September 21, 2023

The Strengthening Medicare for Patients and Providers Act (H.R. 2474) would modify the way the Medicare Physician Fee Schedule (MPFS) is calculated and adjusted each year. The basic system of determining Relative Value Units (RVU) would not change, but the annual adjustment of the Conversion Factor (CF) would more closely reflect the actual economic factors that affect physicians’ practices.

Categories: MPFS, RVU

You Can Help Improve the Medicare Physician Fee Schedule on June 5, 2023

Reimbursement under the Medicare Physician Fee Schedule (MPFS) has been consistently reduced for as many years as most of us can remember. Most recently, the 2023 payment rate was cut another 2.08% from the 2022 level, leaving the fee schedule 7.6% lower than it was in 1998 and 11.0% lower than it was in 2008.

Categories: MPFS, radiology

What Is The Impact Of The 2023 Medicare Fee Schedule On Your Radiology Practice? on February 9, 2023

The Medicare Physician Fee Schedule (MPFS) was lowered for 2023 due to a cut of 2.08% in the Conversion Factor (CF) used to determine payment rates. We reported that the CF could have been reduced as much as 4.47% had Congress not intervened at the last minute to adjust it, along with waiving the 4% PAYGO reduction that was supposed to occur in 2023. The pricing of various procedure codes is also revised annually due to changes in practice expense assumptions, which generally affects the Technical Component (TC) more than the Professional Component (PC). Radiologists will therefore see a different overall result for services in a private office or imaging center than they will for hospital services.

Categories: MPFS, radiology, Medicare Physician Fee Schedule

Last Minute Congressional Action Reduces Medicare Fee Cuts For 2023 on January 4, 2023

In response to concern expressed across the spectrum of physicians and their representative organizations, the omnibus spending bill titled the Consolidated Appropriations Act, 2023 (CAA23) passed by Congress on December 23 rolled back a Medicare payment cut of 8.5%.  As a result, we estimate that the conversion factor will still be cut 2.08% for 2023. However, as we reported previously, many practices will feel a larger reimbursement reduction due to the annual valuation adjustments within the fee schedule.

Categories: radiology reimbursement, MPFS

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

How Will the MPFS Proposed Rule Valuation Changes Impact Radiology? on August 11, 2022

The calculation of reimbursement under the Medicare Physician Fee Schedule (MPFS) is made up of three components, each of which can be adjusted during the annual rulemaking process. The one most discussed is the Conversion Factor (CF), which is the dollar amount applied to the table of Relative Value Units (RVU) to arrive at the reimbursement rate for each procedure; this is known as the National Medicare Fee. However, there is another factor, the Geographic Practice Cost Index (GPCI), that is applied individually to each payment locality across the country. This resulting fee is what is paid to the practice based on the location where the services are performed. The 2023 MPFS Proposed Rule proposes changes to all three components.

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

What’s In Store for Radiology In The 2023 Medicare Proposed Rule? on July 19, 2022

The Centers for Medicare and Medicaid Services (CMS) press release announcing the Medicare Physician Fee Schedule (MPFS) Proposed Rule for 2023 highlights expanded access to behavioral health services, Accountable Care Organizations (ACO), cancer screening, and dental care. Of these areas, cancer screening could be important to radiology practices, but the news was not good – CMS declined to include CT colonography coverage while it expanded coverage for traditional colonoscopy. The MPFS regulates the Medicare fee schedule payment provisions as well as the Quality Payment Program (QPP).

Categories: radiology reimbursement, cms, MPFS, MIPS, MIPS participation, radiology, QPP

Regulatory And Payment Issues That Will Impact Radiology Practices In 2022 on November 23, 2021

Keeping abreast of the various healthcare rules and regulations from federal and state authorities can sometimes be overwhelming for a practice’s management. Here is a summary of some of the most important regulatory issues to be aware of for next year, along with a few payment policy decisions that are not governmental. The links will take you to our recent articles and other sources that probe each topic in more depth.

Categories: cms, MPFS, low dose CT, CPT codes, radiology, QPP, surprise billing

Subscribe to our radiology billing and coding blog

Recent Posts

Testimonial

How a radiology practice recovered lost referrals