HAP Radiology Billing and Coding Blog

With the publication of the Medicare Physician Fee Schedule (MPFS) Final Rule for 2019, which includes the Quality Payment Program (QPP) Final Rule, we can now review how radiologists can prepare to maximize their 2021 Medicare reimbursement through QPP participation in 2019.  The QPP includes both the Medicare Incentive-based Payment System (MIPS) and Alternative Payment Model (APM) tracks.  Since most radiology groups are currently participating in MIPS, we will focus on steps to take for successful participation in this program.

“If you think education is expensive, try ignorance.” Harvard President Derek Bok, et al.

The final rule for the 2019 Medicare Physician Fee Schedule (MPFS) issued by the Centers for Medicare and Medicaid Services (CMS) accepts many of the proposals made earlier this year but some are modified or delayed.

The term “Relative Value Units”, or RVUs, forms the basis for payment of physician fees by Medicare and other payers, and can be used to measure physician productivity for a variety of purposes. Healthcare Administrative Partners (HAP) can help you navigate today's RVU challenges in radiology and maximize your revenue.

In September, we published the article Out-of-Network Balance Billing Laws Are Important for Radiologists to Be Aware Of about the New Jersey law that states patients receiving emergency or urgently needed services will not be required to pay any more than the deductible, copayment or coinsurance they would normally pay whether the hospital and/or its physicians are in-network or out-of-network with the patient’s insurance plan.  Here are some more pieces of information we think you should know:

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. 

New Jersey is the latest state to pass legislation that will affect the amount a radiology practice can collect from patients whose insurance is not accepted by the practice.  While an imaging center would be careful to work with their patients in advance of providing services, the hospital setting does not always afford that opportunity.  It is imperative that you know the laws not only in the state(s) where you practice but also to keep abreast of federal regulations that might impact your billing and collections.

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. 

With the 2017 MIPS reporting year behind us, we now know that practices that achieved the highest possible Final Score of 100 points will receive 2.02% more Medicare reimbursement than the basic fee schedule for 2019.  This increase is compared with the possibility of a 4% payment reduction for practices that did nothing, and a zero-percent adjustment for practices that did the minimum amount of reporting.  In between the minimum level and a perfect score, the fee schedule positive adjustment varies on a sliding scale computed by Medicare.

In today’s healthcare landscape, patients are paying more out-of-pocket for services than ever before. The numbers of people with high deductible health plans and those who are uninsured have risen; often leaving patients with large medical bills and providers struggling to collect the money they are owed.