HAP Radiology Billing and Coding Blog

How the Medicare Final Rule For 2020 Will Affect Radiologists

The Centers for Medicare and Medicaid Services (CMS) has released the annual changes to the Medicare Physician Fee Schedule (MPFS) in its Final Rule that contains not only adjustments to Medicare reimbursement but also revisions to the Quality Payment Program (QPP) for 2020 and beyond.   The MPFS Final Rule does not contain very many significant changes for the coming year, especially for radiology, but one of its provisions will have a far-reaching effect on radiology beginning in 2021. 

Categories: medicare, medicare reimbursement, cms, MPFS, radiology, QPP, quality measures

Pennsylvania’s Act 112 to Become Effective Soon

The “Patient Test Result Information Act”, or Pennsylvania Act 112 of 2018, will take full effect on December 23, 2019.  The Act was originally scheduled to begin in December 2018, but the imposition of citations and fines was delayed for one year.  During that time, many hospitals and radiology practices have implemented systems designed to help them comply with this law. 

Categories: radiology, clinical analytics, PA Act 112

“Closing the Loop”:  What Radiologists Should Know About Software

Any physician who has read about the relatively high award in a recent medical malpractice lawsuit has to be thinking about how they can protect their own practice against a similar outcome from a missed communication with a patient or primary care physician.  In case you missed it, our recent article describes the lessons learned from this case. 

Categories: radiology, clinical analytics

Keeping Your Practice Independent - Build on Existing Relationships

In our recent article we wrote about The Case for Maintaining an Independent Radiology Practice in the Face of Industry Consolidation.  A radiology practice that has served the community with high quality services over many years naturally has developed relationships that can be drawn upon to strengthen its position, and avoid what might otherwise seem to be the imperative to become absorbed by some larger entity.   Some of those existing relationships include the hospital served by the group, its referring physician community and neighboring radiology practices.

Categories: radiology, consolidation

Lessons Learned – Incidental Findings in Radiology

The recent award of $10 million in a medical malpractice lawsuit is noteworthy not only for the high amount of the award, but also for what can be learned from the case.  It highlights the consequences of poor patient communication and lack of appropriate follow-up. 

Categories: radiology, incidental findings

First Look at the New Medicare Rules for 2020

The Centers for Medicare and Medicaid Services (CMS) released their annual proposal for changes to the Medicare payment system for the coming year, and they also released new information about the existing mandate for the use of Clinical Decision Support (CDS) beginning in 2020.  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 2020 and beyond.

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

The Case for Maintaining an Independent Radiology Practice in the Face of Industry Consolidation

We are clearly in an era marked by the consolidation of healthcare services into fewer but larger providers, involving not only hospital systems but physician groups as well.  Radiology practices are not immune to this trend.  The study Radiology Practice Consolidation: Fewer but Bigger Groups Over Time published in April by the Journal of the American College of Radiology shows that practices consisting of 100 or more radiologists grew significantly between 2014 and 2018, while practices of fewer than 100 radiologists declined.  There are many reasons local practices feel the need to become larger, but at the same time there is usually a lot of trepidation among the physicians about joining with another organization.  Before jumping on the merger bandwagon, be sure you’ve considered the ways you can achieve your goals while remaining independent.

Categories: radiology, patient experience, mergers, consolidation

CMS Releases a New Resource on the MIPS Cost Category

Radiologists are most likely not paying much attention to the Merit-based Incentive Payment System (MIPS) Cost category because no specific action is needed to report data, and usually radiology groups have little control over the cost attributed to a patient.  The Centers for Medicare and Medicaid Services (CMS) has released a new MIPS resource on the Cost performance category that provides good information on this aspect of the MIPS scoring.  This affords a good opportunity to review the Cost category and better understand its potential impact on your practice.

Categories: cms, MIPS, MIPS participation, radiology

Update on Interventional Radiology Coding and Billing

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

How Radiologists Can Avoid Penalties Under the Medicare CDS/AUC Mandate

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

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