HAP Radiology Billing and Coding Blog

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

Medicare’s AUC/CDS Mandate Will Begin Next Year

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.

Categories: radiology reimbursement, radiology documentation, CDS, radiology, AUC

The Importance of Accepting Electronic Payments at Your Radiology Practice

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.” 

Categories: radiology reimbursement, medical billing, patient billing, patient collections, radiology, patient experience

A Review of the ACR’s Comments On The Medicare Physician Fee Schedule Proposed Rule For 2019

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. 

Categories: radiology reimbursement, MPFS, radiology

How the Proposed Medicare Fee Schedule Changes Will Impact Radiology Practices

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. 

Categories: radiology reimbursement, interventional radiology, MPFS, radiology

The Future for Radiologists in the QPP

Recently reported developments in federal health care policy could change the direction radiologists are taking to maintain maximum Medicare reimbursement. 

Categories: radiology reimbursement, medicare, medicare reimbursement, Quality Payment Program, radiology, QPP

Radiology Documentation Guidelines for Optimized Coding and 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.

Categories: radiology reimbursement, physician reimbursement, radiology documentation, radiology

Update on Billing for y-90 Radioembolization Procedures

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

CMS Issues Its Proposed 2018 Medicare Physician Fee Schedule Rule

The annual regulatory cycle of review, comment, planning and preparation has begun with the release of the Medicare Physician Fee Schedule (MPFS) Proposed Rule for 2018. In its preliminary review of those sections of the MPFS that will be of specific interest to radiology practices, The American College of Radiology (ACR) includes a statement that “the ACR is pleased with several provisions within the rule.”  They highlight the planned implementation of the Appropriate Use Criteria and Clinical Decision Support rules beginning January 1, 2019 and the proposal to leave the technical component of mammography services unchanged rather than lowering it by 50% as previously discussed. 

 

Categories: radiology reimbursement, cms, MPFS, radiology

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