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.
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.
Interventional radiologists are often called to perform peripherally inserted central venous catheter (PICC) prodecures. Recent coding and policy changes bundle all imaging guidance and the confirmation of final placement into a single CPT® code. Let’s review the financial implications of those changes.
Our review of the proposed 2019 Medicare Physician Fee Schedule (MPFS) showed that 201 Professional Component (PC) codes and 213 Global codes were to be decreased by at least 1% in the Diagnostic Radiology 70000-series of CPT codes. In the final MPFS, only 46 PC codes were reduced by 1% or more, but 280 global codes were reduced by at least 1%. The number of codes expected to increase in payment did not change as dramatically, but in both PC and Global billing fewer codes were increased than we expected. Here are the details:
We’ve been watching the development of the Appropriate Use Criteria/Clinical Decision Support (AUC/CDS) requirement since 2014 when it was first included in the Protecting Access to Medicare Act (PAMA 2014). The latest Medicare Physician Fee Schedule (MPFS) confirms that the requirement to use CDS will begin this coming year on January 1, 2020, but imposition of any penalties associated with the referring physician’s failure to do so will be delayed until 2021. We are currently in a voluntary reporting period that runs through the end of 2019, so it’s a good time for every radiology practice to review where it stands with regard to this important Medicare regulation.
In our article Best Practices in Radiology Patient Billing, we identified a greater focus on practice billing processes as a critical element in improving patients’ satisfaction with the practice, and we encouraged practices to accept electronic payments. According to the InstaMed Trends in Healthcare Payments Eighth Annual Report 2017 released in May 2018, “Consumer loyalty is increasingly tied to the healthcare payments experience as 65 percent of consumers would consider switching healthcare providers for a better healthcare payments experience.”
The American College of Radiology (ACR) does a very thorough job of reviewing and commenting on proposed federal legislation such as the annual changes to the Medicare Physician Fee Schedule (MPFS). Their 59-page letter of September 10, 2019 to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), is available on the ACR website for radiologists to review in detail.
CMS, the Centers for Medicare and Medicaid Services, is constantly on the lookout for procedure codes that it feels do not reflect the current cost or complexity of practice in their valuation. The annual Medicare Physician Fee Schedule (MPFS) rule modifies many codes with varying degrees of impact to radiology practices.
Recently reported developments in federal health care policy could change the direction radiologists are taking to maintain maximum Medicare reimbursement.
In radiology, like all other medical specialties, proper documentation is critical to achieving appropriate reimbursement. If the proper terminology is no used or important descriptors are omitted from the radiology report, the physician may not get paid for the services he or she performed.