HAP Radiology Billing and Coding Blog

Rural Care Settings Need More Radiology Expertise on December 8, 2022

Recently, a study by a joint task force of the American College of Radiology (ACR) and the Society of Interventional Radiology (SIR) pointed out the need for all diagnostic radiologists to have certain competencies in “Level 1” interventional procedures. Radiology Business reports that the aim of the task force was making recommendations for “broadening access to image-guided procedures for patient populations living in rural care settings or served by small IR practices.” According to the study abstract, “Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists”, resulting in a failure to meet the needs of patients and others in these communities. Thus, having diagnostic radiologists with Level 1 competencies in small practice or rural health settings increases their ability to provide a wider range of needed services.

Categories: interventional radiology, radiology, rural health

Regulatory Update – Radiology Faces Revenue Cuts In 2023 on December 2, 2022

Once again this year, physicians are uncertain about the amount of reimbursement reduction they will suffer from Medicare cuts. If things are left unchanged, Medicare providers will face a reduction of approximately 8.5% across the board, without considering adjustments made to specific procedure codes. In recent years last-minute congressional action has mitigated the effect of certain statutory requirements.

Categories: medicare, medicare reimbursement, radiology, Medicare Physician Fee Schedule

The Medicare Final Rule Confirms Big Payment Reduction For 2023 on November 15, 2022

When the 2023 Medicare Physician Fee Schedule (MPFS) was proposed earlier this year it projected a 4.42% cut to the conversion factor (CF), with radiology facing cuts of between 3 – 4% depending on subspecialty. The final rule moves the cut even deeper, with the 2023 CF set 4.47% lower than the 2022 CF.

Categories: medicare, medicare reimbursement, MPFS, radiology, Medicare Physician Fee Schedule

Diagnosis Coding Changes for Radiology are Available Now on November 3, 2022

Although we refer to the annual updates to the ICD-10-CM[1] coding system as being for the coming year of 2023, they are effective and available for use on October 1, 2022.

Categories: radiology coding, icd-10, radiology

Expanded Authorization for Non-Physician Providers on October 25, 2022

The opportunities for non-physician providers (NPP) in radiology practices continue to expand. Recently the American College of Radiology (ACR) revised its CT and MRI facility accreditation criteria to allow NPPs to be able to directly supervise contrast administration. This mirrors the revised practice parameter for supervision of contrast administration that was previously adopted by the ACR. Note, however, that state licensure laws are the final authority that determine which services may be provided by NPPs.

Categories: radiology reimbursement, radiology, NPP, Non-Physician Provider

Top 3 Threats To Independent Radiology Practices on October 17, 2022

Many radiologists prefer an independent practice model for a variety of reasons. Lifestyle and benefits (especially vacation and retirement) are often enhanced in a private practice. In the workplace, private practice offers more control over corporate culture along with the ability to structure the practice and its subspecialty focus in a way that best meets their patients’ needs. There is better opportunity for management of administrative and clinical time to accomplish research projects, journal articles, and continued professional growth. However, there are always challenges to maintaining practice independence, including staffing, consolidation, and legislative and environmental pressures.

Categories: radiology, practice independence, practice governance

What Will the MIPS Value Pathways Option Mean for Radiology Practices? on September 21, 2022

Beginning in 2023, physicians will have the option to report under the Medicare Quality Payment Program (QPP) using MIPS Value Pathways (MVP) in lieu of the traditional reporting methods. MIPS, the Medicare Incentive-based Payment System, started gathering performance reports in 2017 and in 2019 the first Medicare payment adjustments were made based on that 2017 reporting. Eventually traditional MIPS reporting will be phased out, but the Centers for Medicare and Medicaid Services (CMS) has not proposed a timeline for doing so.

Categories: radiology reimbursement, MIPS, MIPS participation, radiology

The No Surprises Act Final Rule Changes the IDR Process on September 14, 2022

The Final Rule related to the No Surprises Act (NSA), issued August 26, 2022, clarifies and modifies the Independent Dispute Resolution (IDR) process but makes no changes to the patient protections and other provider obligations of the NSA, such as notifications and cost estimates for uninsured patients. The IDR process has been the most controversial part of the NSA, especially the stipulation of the Qualifying Payment Amount (QPA) as the primary determinant of reimbursement. The rule finalizes disclosures that insurance payers must share about the QPA and it addresses the information to be considered in the determination of payment under the IDR process.

Categories: radiology, No Surprises Act

Essential Steps to Smooth Practice Governance on September 1, 2022

Practice governance involves hands-on, day-to-day management and oversight, along with a strong basis in group culture and structure. The group’s structure and to some extent its culture is defined in its ownership and operating documents. Our article “Essential Steps to Smooth Practice Governance” that was initially published in the May/June 2022 (Volume 57, Issue 3) edition of the Radiology Business Management Association’s RBMA Bulletin offers a complete review of steps to help your practice operate smoothly through adherence to its foundation documents.

Categories: radiology, practice governance

How Will the MPFS Proposed Rule Valuation Changes Impact Radiology? on August 11, 2022

The calculation of reimbursement under the Medicare Physician Fee Schedule (MPFS) is made up of three components, each of which can be adjusted during the annual rulemaking process. The one most discussed is the Conversion Factor (CF), which is the dollar amount applied to the table of Relative Value Units (RVU) to arrive at the reimbursement rate for each procedure; this is known as the National Medicare Fee. However, there is another factor, the Geographic Practice Cost Index (GPCI), that is applied individually to each payment locality across the country. This resulting fee is what is paid to the practice based on the location where the services are performed. The 2023 MPFS Proposed Rule proposes changes to all three components.

Categories: radiology reimbursement, MPFS, radiology, Medicare Physician Fee Schedule

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