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.
The Future for Radiologists in the QPP on July 25, 2018
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.
Update on Billing for y-90 Radioembolization Procedures on November 7, 2017
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.
CMS Issues Its Proposed 2018 Medicare Physician Fee Schedule Rule on July 25, 2017
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.
New information has been provided by The Centers for Medicare and Medicaid Services (CMS) that will supplement our article An Update for Radiologists on Appropriate Use Criteria and Clinical Decision Support. We can now update you from the recent release of the “Proposed Medicare Physician Fee Schedule (MPFS) for 2018” and the “Proposed Rule for Quality Payment Program Year 2.”
Patients in rehabilitation facilities sometimes need imaging services that cannot be provided within the facility itself. Imaging centers willingly accept these patients but they can inadvertently fall into a collections quagmire if they aren’t aware of the Medicare rules related to skilled nursing facilities.
Best Practices in Radiology Patient Billing on June 19, 2017
Maximizing the patient experience is no longer limited to the achievement of clinical success. It is a critical component of the new, broader partnership between provider and patient – one that now encompasses conversations regarding not only service quality and cost, but also places a greater focus on practice billing processes in line with the higher demands inherent to the new patient consumerism trend.
Radiologists are understandably nervous about the Medicare rule requiring the use of Appropriate Use Criteria and Clinical Decision Support (AUC/CDS) systems.