The 2012 Hit List: Code Pairs That Meet the 75% Threshold

July 04, 2011 | NONE

Radiology first felt the effects of the bundling initiative launched by CMS in 2010, with the creation of combined CPT® codes for myocardial perfusion, wall motion, and ejection fraction (78451–78454); arteriovenous shunt dialysis-catheter procedures, along with radiological supervision and interpretation (36147 and 36148); and facet-joint injection procedures that include imaging guidance (64490–64495).

The Great CT Bundling Heist of 2011

July 04, 2011 | Feature

Medicare is looking for misvalued imaging codes—and it has already found several for which it has reduced payment. Its efforts have dismayed radiologists. Facing more revenue losses from CMS and the private insurers that follow in the agency’s footprints, radiologists feel targeted and, as a specialty, misvalued... Read More »

The Triple Threat of Bundling Codes

July 04, 2011 | The Bottom Line

Radiology’s existing coding structure is undergoing a dramatic transformation, which is the product of numerous code screens being used by CMS and the RVS Update Committee to identify potentially misvalued services. The application of these code screens often results in the conversion of old codes to new codes.... Read More »

Your Undivided Attention

July 04, 2011 | Adview

The June 2011 MedPAC Report to the Congress1 has the undivided attention of the entire specialty, just days after its release—for good reason. Pages 27 through 59 detail the commission’s recommendations to curtail further the amount of imaging occurring in medicine and to redistribute professional income from image-reading specialties to... Read More »

Reimbursement Outlook for 2011: Trouble on the Way

December 12, 2010 | Regulatory Report

On November 30, the Physician Payment and Therapy Relief Act of 2010 was signed into law, delaying the 23% Medicare physician-payment cut mandated by the sustainable growth rate formula. The legislation replaced the cut with a 2.2% update through December 31, with the intention of giving Congress time to find a more permanent solution.... Read More »

The Good-news, Bad-news Economic Scenario

November 28, 2010 | Reimbursment

The list of entities with imaging in their crosshairs goes on and on, but when it comes to eroding reimbursement and enhancing oversight, the current primary culprits are CMS and Congress, according to Maurine Spillman-Dennis, MBA, MPH, director of economics and government relations for the ACR®. In the “ACR... Read More »

Radiology and the MPFS: Implications and Impact

August 15, 2010 | Revenue Track

CMS released the 2011 Medicare Physician Fee Schedule (MPFS) in July, proposing myriad changes that CMS notes would result in a 6% payment cut for radiology services. That reduction doesn’t include the impact of... Read More »

A Step-by-step Guide to Implementing PQRI

June 16, 2010 | A Better Mousetrap

The 2006 Tax Relief and Health Care Act required the establishment of a physician quality reporting system. The requirement called for an incentive payment for eligible professionals who satisfactorily report... Read More »

Capitation:  An Inevitability Waiting to Happen

April 28, 2010 | The Bottom Line

Regardless of the effects of health-care reform, the United States cannot continue on the current health-care track, given deep, multiyear federal budget deficits. It is simply not sustainable, at a cost of more than 16% of the gross domestic product (GDP)¹; in comparison, socialized medicine in the United Kingdom... Read More »

DRA II: CMS Proposes Slashing the Technical Component Again

October 02, 2009 | Priors

A proposed 90% equipment-utilization formula and brand-new lowball practice-expense data courtesy of the AMA will deal radiology a new round of cuts comparable to those contained in the DRA. The specialty faces dramatic cuts to the technical component in the proposed 2010 Medicare Physician Fee Schedule (MPFS), and these have triggered... Read More »

OIC Reimbursement: The Multipronged Attack

September 11, 2009 | Revenue Track

In an illustration used for hospital clients, analyst Shay Pratt pinpoints imaging centers for sale around the country: four independents on the market in California, a four-center chain in Kansas, and a larger chain in central Florida with an asking price of $22.5 million. The list, with size and price... Read More »

MSDRGs: Pitfalls and Opportunities

July 26, 2009 | Reimbursment

Ernest Glad, president of Cortell Health, Dallas, Texas, sees the 2007 CMS restructuring of the DRGs used in the inpatient prospective-payment system as an opportunity that many hospitals are currently squandering. The restructuring adjusts DRG weights based on the severity of a patient’s condition to improve the system... Read More »

Further TC Cuts Ahead?

March 01, 2009 | Priors

Due to inequities in payment methodology, are providers of imaging services overpaid?

That question is raised, along with others, in a provocative article by Winter and Ray,¹ two analysts for the Medicare Payment Advisory Commission (MedPAC), that was published in a recent issue of Health Affairs. In... Read More »

Revised Anti-markup Rule: CMS Gets Creative

December 16, 2008 | Regulatory Report

On November 19, 2008, CMS issued the Medicare Physician Fee Schedule (MPFS) for calendar year 2009. Consistent with the CMS trend of introducing substantive regulatory changes in payment rules, the MPFS Rule contained a number of significant revisions, including the closely watched anti-markup provisions applicable to diagnostic services other than clinical diagnostic... Read More »

The Dynamics of Reimbursement and High-quality Care

September 15, 2008 | Radiology Business Journal

Access to high-quality patient care is a cornerstone of customer-focused service delivery, Michael A. Silver, PhD, says. In turn, that goal is supported by technology that enhances performance and allows the imaging provider to do more with less. Part of making less go further is maximizing reimbursement through better... Read More »

Proposed 2009 MPFS: Once Again, Imaging Takes a Disproportionate Impact

August 15, 2008 | Legislative Report

In what seems to be becoming as much a harbinger of summer as fireworks or cookouts, on July 7, 2008, CMS published its proposed Medicare Physician Fee Schedule (MPFS) payment update for the next fiscal year. Once again, it includes a number of provisions intended to address CMS concerns about the... Read More »

CT Colonography: Ready for Prime Time

July 15, 2008 | Regulatory Report

On June 18, 2008, a letter was sent to the CMS Coverage and Analysis Group seeking approval of CT colonography (CTC) as a generalized screening tool for colorectal cancer among asymptomatic Medicare patients 50 years of age or older. The letter itself was a calm recitation of years of evidence collected through... Read More »

Radiology Income Distribution: From Salary to Independent Practice to Megapractice

June 15, 2008 | Feature

A CPA offers his perspective on the past and future of radiologist compensation, based on 30 years on the business side of radiology

Hospital-based physicians (radiologists, anesthesiologists, and pathologists) were either compensated as salaried employees or were members of unincorporated entities paid by the hospital well into the 196... Read More »

Contract Evaluations: The Devil in the Details

June 12, 2008 | Revenue Track

An adage of the legal profession holds that if you’ve seen one contract, you have seen exactly one contract. That is never truer than when the contract in question is between an imaging center and a payor, even though 90% of the agreement’s language will have been cast... Read More »

2008 Update on Non-hospital-based Outpatient Medicare Reimbursement

May 15, 2008 | Regulatory Report

As part of GE Healthcare’s commitment to ongoing monitoring of the reimbursement situation, GE presented a Webcast on this topic on May 7, 2008. Called the 2008 Reimbursement Environment for OICs, the program was presented by Michael Becker, general manager, reimbursement, and John Schaeffler, manager, federal government relations, both of GE... Read More »

A Thorny Question: Who is Responsible for Transcription Costs?

March 15, 2008 | Regulatory Report

Radiology practices and hospitals historically have operated under the assumption that the cost of transcription is part of the technical component, and therefore the responsibility of the hospital, or the entity that owns the technology. While there have been periodic attempts by hospitals to charge radiologists for transcription services... Read More »

The Shifting Landscape of Cardiac CT Angiography Reimbursement

February 15, 2008 | Reading Room

Many imaging providers have been wishing for changes in reimbursement policies for cardiac CT angiography (CCTA) for some time. Changes are about to be made, but those wishes may not be granted. In December 2007, CMS proposed major restrictions on coverage for CCTA that could take effect as early as... Read More »

Practice Buyouts: What Should a Departing Physician Really Receive?

January 15, 2008 | Revenue Track

The largest asset of a radiology practice is the cash value of its accounts receivable, and that valuation is prominent in the deferred-compensation package for a retiring member. The language in that section of the employment agreement generally stipulates a formula that is based on historic collection ratios taken... Read More »

Legislative Update: Calculating the True Cost of the DRA

October 15, 2007 | Legislative Report

As the medical imaging industry is well aware, the Deficit Reduction Act of 2005 (DRA), effective January 1, 2007, directed severe reductions in payments for many imaging services in the physician office and independent facility setting. Under the DRA, the payment for the technical component (e.g., equipment, non-physician personnel, supplies, and... Read More »

EMI: The Last Cost-Cutting Frontier

June 12, 2007 | Legislative Report

The changing outpatient imaging business environment has made it imperative for all radiology managers to continually reduce operating expenses. Reimbursements are being squeezed by the recent Deficit Reduction Act (DRA) cuts and the multi-body part discount. The recently published Moran report, sponsored by the Access to Medical Imaging Coalition ... Read More »