The workload of a radiology practice doesn’t diminish when one of the physicians is away, either on leave or due to termination, and one way to cope with the shortfall of staff is to use a temporary physician service. Knowing how to properly bill for those services is essential to maintaining cash flow in compliance with the regulations.
When & How to Bill For Locum Tenens Services In The Radiology Practice on March 22, 2022
Categories: radiology billing, radiology, locum tenens
Medicare Announces Prior Authorization Requirement on July 23, 2020
Radiologists who perform venous ablation in a hospital outpatient department are now required to obtain prior authorization before performing such services on Medicare patients. This new requirement became effective for services performed on or after July 1, 2020, and physicians were notified by letters from the Centers for Medicare and Medicaid Services (CMS) late in June. The prior authorization requirement was included in the 2020 Hospital Outpatient Prospective Payment System (HOPPS) Final Rule, and encompasses the following procedures that might be performed by interventional radiologists:
Categories: radiology reimbursement, radiology billing, interventional radiology, cms, interventional radiology billing
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
Get Ready for Changes to Radiology Billing in 2020 on December 23, 2019
Our own Sandy Coffta, Vice President of Client Services, spoke with Aunt Minnie’s Brian Casey at the 2019 RSNA Annual Meeting in Chicago. In the interview posted on auntminnie.com, Sandy mentioned some of the highlights that practices should be concerned about in the coming year.
Categories: radiology reimbursement, radiology billing, radiology documentation, radiology coding, radiology
Update on Surprise Billing Legislation Across the Country on December 18, 2019
In the absence of federal regulation, states are adopting laws intended to protect patients from high out-of-pocket costs when they unexpectedly receive services from out-of-network (OON) providers. When a patient receives an unexpected bill following such OON services the situation is known as “surprise billing.” Not all OON billing falls into the category of “surprise billing,” however. In many cases, patients understand that the services they are receiving are OON and they expect to pay all or part of the bill.
Categories: radiology reimbursement, radiology billing, surprise billing
Update on Interventional Radiology Coding and Billing on May 30, 2019
Read our 2021 IR billing & coding article
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
Just as you were done revising your practice systems and processes for Meaningful Use and MACRA/MIPS, a new Medicare mandate came along. One of the biggest challenges for radiology practices right now is to be able to comply with the requirement that ordering physicians use a Clinical Decision Support Mechanism (CDSM) to consult Appropriate Use Criteria (AUC) when ordering MR, CT, PET and other specified nuclear medicine exams. This rule has been on the books since 2014, but it will begin to be implemented in 2020 followed by the imposition of penalties in 2021. This is not a voluntary bonus like Meaningful Use, or the avoidance of a small fee reduction under MIPS, but rather it means there will be NO payment to the radiologist for procedures performed without using the appropriate process.
Categories: radiology billing, MIPS, MACRA, CDS, MIPS participation, radiology, AUC
An update on Out-of-Network Balance Billing Laws Are Important for Radiologists to Be Aware Of on October 18, 2018
In September, we published the article Out-of-Network Balance Billing Laws Are Important for Radiologists to Be Aware Of about the New Jersey law that states patients receiving emergency or urgently needed services will not be required to pay any more than the deductible, copayment or coinsurance they would normally pay whether the hospital and/or its physicians are in-network or out-of-network with the patient’s insurance plan. Here are some more pieces of information we think you should know:
Categories: radiology billing, radiology
Out-of-Network Balance Billing Laws Are Important for Radiologists to Be Aware Of on September 17, 2018
New Jersey is the latest state to pass legislation that will affect the amount a radiology practice can collect from patients whose insurance is not accepted by the practice. While an imaging center would be careful to work with their patients in advance of providing services, the hospital setting does not always afford that opportunity. It is imperative that you know the laws not only in the state(s) where you practice but also to keep abreast of federal regulations that might impact your billing and collections.
Categories: radiology billing, radiology
Update on Billing for y-90 Radioembolization Procedures on November 7, 2017
Click here to read our October 2020
y-90 radioembolization article
Our 2014 article "Interventional Radiology Meets Radiation Oncology – The y-90 Story” focused on the documentation requirements that will assist coders to maximize reimbursement for this complex procedure. Those documentation tips are still valid today. This update reviews the 2017 state-of-the-art in coding for y-90 procedures.
Categories: radiology reimbursement, radiology billing, radioembolization, interventional radiology, nuclear medicine, y-90, radiology