HAP Radiology Billing and Coding Blog

In 2019 we were writing about The Case for Maintaining an Independent Radiology Practice in the Face of Industry Consolidation. Since then, the world has changed dramatically due to the global COVID-19 pandemic. Practice revenue streams were disrupted, while the expenses of operating the practice were ongoing. Radiologists in private practice had to cope with the stress of holding the practice together through the uncertainty. Did the public health emergency alter their thinking about remaining independent, or did it push more of them toward selling the practice to a larger entity?

Benchmarking is a current term used to describe a process that has always been applied but perhaps not in the same way as it is today. That process involves comparing business statistics to historical data or to the same type of data gathered across a wider spectrum. In our May 2019 article How Benchmarking Can Help Radiology Practices Evaluate Their Productivity, we discussed the use of RVUs (Relative Value Units) as a measure of radiologist productivity. This is only one statistic, or metric, that can be used to evaluate a practice’s performance.

The No Surprises Act* will become effective January 1, 2022. This is the first federal regulation that is aimed at protecting patients from receiving unexpected bills from healthcare providers who are outside of their insurer’s network. Review our recent article for an overview of its provisions.

The radiology community is abuzz with talk of artificial intelligence (AI) systems that can assist physicians with image interpretation and perform other tasks. Like any new technology, it will take time before AI gains widespread acceptance due to the cost of implementation. This is analogous to the early-day PACS, where the benefits of efficiency had to be proven in order to justify the expenditure for such a costly system. Today almost all imaging is interpreted on computer systems … when was the last time anyone looked at a piece of film?

At around this time last year we were beginning to learn about the various ways medical practices could make use of federal programs to help keep them afloat through the COVID-19 pandemic. No one knew how long it would last. As time went on, we followed the changes to those programs, the new programs that became available, and the deadlines for action. Let’s review the latest federal legislation and also where each of last year’s relief programs stands today, especially the Medicare Payment Sequester that is a developing story.

The issue of patients receiving large, unexpected medical bills from hospitals and physicians has been widely publicized. This situation, known as surprise billing, arises when a hospital or physician provides medical care to a patient but is not participating in a patient’s insurance network. We have reported on the many states that have put legislation in place to try and mitigate the problem for their own residents, but now there will be a nationwide policy thanks to recent federal legislation.

From Wednesday, February 24 to Wednesday, March 10, practices with fewer than 20 employees will have a preferential opportunity to obtain a loan under the Paycheck Protection Program (PPP). According to the Small Business Administration (SBA), “This will give lenders and community partners more time to work with the smallest businesses to submit their applications, while also ensuring that larger PPP-eligible businesses will still have plenty of time to apply for and receive support before the program expires on March 31, 2021.”

When the Medicare Physician Fee Schedule (MPFS) Final Rule was published in December, it looked like radiology was facing a significant cut in Medicare reimbursement for 2021. Our article reported that professional component fees would drop 10-11% while global reimbursement would see a lesser impact. The Consolidated Appropriations Act, 2021 (CAA) rolled back those cuts at least for 2021, although the Medicare fee schedule for radiology will likely continue to be adjusted downward in the future as implementation of the revalued Evaluation and Management (E&M) services is fully phased in.

The “Consolidated Appropriations Act, 2021” (CAA) is a sweeping piece of legislation that provides relief to individuals and businesses impacted by the COVID-19 public health emergency. Some of the relief provisions apply to all businesses, including medical practices, but it also contains several measures that specifically apply to medical practices.

Click here to read our 2025 code changes update article.

The big news in Current Procedural Terminology^[i] (CPT)^® revisions for 2021 is the overhaul of the Evaluation and Management (E&M) section, reducing documentation requirements, and introducing new rules for determining the level of coding. These changes will affect interventional radiologists and radiation oncologists more than they will the day-to-day work of diagnostic radiologists. First, we will review the other non-E&M code changes affecting diagnostic and interventional radiology for 2021.