HAP Radiology Billing and Coding Blog

Get Feedback on Your 2019 Quality Payment Program Performance

Quality Payment Program (QPP) participants can now obtain information about whether their practice will receive a positive, negative, or neutral Medicare fee schedule adjustment in 2021 based on the 2019 data they submitted. The Centers for Medicare and Medicaid Services (CMS) announced that clinicians who participated in the Merit-based Incentive Payment System (MIPS) in 2019 can access their performance feedback by logging in to the Quality Payment Program website

Categories: radiology reimbursement, physician reimbursement, cms, Quality Payment Program, QPP, quality measures

Radiology’s Declining Reimbursement Spans More Than A Decade

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

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

Medicare Announces Prior Authorization Requirement

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

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

What the January 2020 Update to the Medicare AUC/CDS Mandate Means for Radiologists

It’s a cold January here in the northeastern US, so it’s a good time to heat up plans to comply with the Medicare AUC Mandate!  We have entered the official Educational and Operations Testing Period of 2020, which means that Medicare is ready to accept the Appropriate Use Criteria (AUC) modifiers and G-codes on claims now being submitted.  Let’s first review what this Medicare mandate means and then make plans to get it operational in your practice.

Categories: radiology reimbursement, medicare, cms, CDS, AUC

Get Ready for Changes to Radiology Billing in 2020

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

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

The Value of PICC Lines for Interventional Radiologists

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.

Categories: radiology reimbursement, medicare reimbursement, interventional radiology, PICC

Understanding The Valuation Changes In The Final Medicare Fee Schedule For 2019

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:

Categories: radiology reimbursement, interventional radiology, MPFS, radiology, diagnostic radiology

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