Whitney Palmer

Healthcare. Politics. Family.

Proposed Cuts Lead to Radiology Practice Self-Analysis

Published on the Nov. 14, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

When CMS released its 2013 proposed Medicare payment cuts this month, no one in radiology was particularly surprised. Industry experts knew radiology settings and providers faced slashed reimbursement rates, and it’s now time for practices to assess just how affected they might be.

In the fee schedule, set for Jan. 1, 2013, implementation, CMS retained its proposed multiple procedure payment reduction (MPPR) of 25 percent to the professional component (PC) for CT, MRI, and ultrasound imaging conducted by one or more providers in the same practice on the same patient, during the same session, on the same day. The Medicare proposed cuts will also decrease overall payments to radiation therapy centers by 9 percent and reduce payments to radiation oncology providers by 7 percent.

Overall reaction, said Maurine S. Dennis, senior director of economics and health policy at the American College of Radiology, is that these proposed reductions are both arbitrary and complicated. The MPPR cut is creating significant angst, she said.

“It’s a cut — a cut to the professional component, so it’s real money out of our providers’ pockets,” she said. “The proposal deals a lot with subspecialists, and it’s complex. It’s going to take time to figure out how everything will shake out.”

The looming 25 percent MPPR cut isn’t the only problem, however, said Mike Mabry, executive director of the Radiology Business Management Association. CMS has also yet to publish any information or guidance about the new coding modifier it plans to implement for same-day, same-provider services. Currently, your coders use the -59 modifier to identify procedures done on the same day that are distinct from all others performed.

In addition, the agency has not released a definition for what it considers to be same-session, leaving practices to determine for themselves how best to process this type of claim. The best course of action, Mabry said, is for practices to conduct a self-assessment of how at-risk they are for MPPR PC payment cuts.

Practices that provide a higher level of tertiary care or other advanced diagnostic imaging services should conduct the most involved analyses of their same-day, same-session services. These settings, he said, will be the most vulnerable to the MPPR PC reduction and will feel the greatest impact on their bottom line.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2114454


November 14, 2012 Posted by | Healthcare, Politics | , , , , , , , , , , , , , | Leave a comment

What Health Reform Means for Radiologists

Published on the Aug. 11, 2011, DiagnosticImaging.com Web site

By Whitney L.J. Howell

The health care system as you’ve known it will look drastically different within the next few years, and the radiology industry is set to change with it. If you want to stay afloat and have a competitive practice, you must know which parts of the health reform legislation will affect you and how to handle them.

That’s the message from Robert Still, MD, practice manager for Lancaster Radiology Associates Ltd. in Auburn, Pa. Speaking at the AHRA: The Association for Medical Imaging Management annual meeting in Dallas next week, Still says accountability will be the most important thing to remember as health reform legislation comes online.

“The ways we measure quality in health care and radiology will change. The focus will be higher quality at lower cost,” he said. “As accountable care organizations are introduced, all payments will be bundled and reimbursements will be value based.”

This bundling means you will no longer be reimbursed separately for your services. Instead, your payments will be part of a larger one that includes facility, technical, and physician charges. It could also mean you start assuming a more consultative role in patient care, offering input and making recommendations about which imaging studies are most appropriate, Still said.

This change has industry leaders concerned. They fear policymakers are following MedPAC’s lead in considering bundles or cuts to all the payment codes you use.

“There will be a huge impact in reimbursement if every code is up for grabs,” said Maurine Dennis, senior director of economics and health policy at the American College of Radiology. “Diagnostic radiology is behind the 8-ball and is feeling the biggest impact from reform.”

To read the entire story: http://www.diagnosticimaging.com/healthcare_reform/content/article/113619/1926311?CID=rss&cid=dlvr.it


August 11, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , | Leave a comment


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