HAP Radiology Billing and Coding Blog

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.

The Centers for Medicare and Medicaid Services (CMS) has combined its rule making for both the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP) into one document for its 2019 proposal.  This article will summarize the elements of each area that will most affect radiology practices if they are ultimately finalized and become law later this year. 

Healthcare reform is forcing ongoing risk vs. reward debates that seek consensus on the ideal balance of cost expenditure and patient care quality. As a prime example: the issue of if and how to best handle patients with incidental imaging findings receives continued scrutiny. This Reuters article summarizing a recent study in the British Medical Journal (BMJ) highlights the complexities inherent to developing standards of care for the major types of incidentalomas. It also reveals key insights that can be used for the benefit of radiology practices and patients alike.  

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

Consumerism in the world of healthcare means that patients are taking a more active interest in the cost and quality of the services they receive.  They have been forced to foot the bill for an ever-larger share of the total cost, and they want to make sure they are receiving the highest quality for their expenditure.  We have written before about the impact of today’s high-deductible health insurance plans, and thus far the slow dissolution of the Affordable Care Act is not causing employers or insurers to back down from those high deductibles. 

In an article published in the online Journal of the American College of Radiology¹, authors from Duke University Medical Center Department of Radiology present a study conducted to demonstrate the variability and complexity of radiologists’ dictated notes. The authors chose to analyze the language used to describe normal thyroid glands in chest CT reports as a “surrogate for the broader readability of radiology reports”. In a sample of nearly seven thousand non-contrast chest CT reports, the researchers found 342 unique sentences or phrases describing a normal thyroid gland. Furthermore, linguistic analysis suggested that descriptors for a normal thyroid gland require an advanced college-level education for comprehension. This text is well above the national average health literacy level and results in reports that are difficult for patients to understand.²

In our recent article we explored the ways radiology groups can begin to move toward participation in Alternative Payment Models (APM*) as an option in place of working within MIPS under the Medicare QPP.  But what does APM participation mean for a radiology practice, and what should radiologists look for to begin moving in this direction? 

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.

Our recent article How Radiology Practices Can Drive True Quality of Care describes how the use of clinical data can be integrated with a business process to provide benefits for both patient care and practice value.  Expanding this concept to the next level triggers the imagination – what other types of cases in the practice need follow-up within specific time periods?  Thus came the idea for the second iteration of HAP’s clinical analytics solution deployment that involved patients with implanted inferior vena cava (IVC) filters.

A recent study^[1] published by the Journal of the American College of Radiology concludes that clinicians prefer radiology reports in a more structured format over those in a “more traditional, prose style”.  This finding supports the position we at Healthcare Administrative Partners have long advocated.  Our May 2016 article points out the many benefits of structured reporting, which include easier transition to clinical decision support systems, compliance with quality reporting standards, and fewer denials from payers for questions of medical necessity or coding at the appropriate level of service.