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

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

Radiology Leadership: Proposed Reimbursement Cuts “Arbitrary”

Published on the July 12, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

A new round of potential cuts to radiology reimbursement has many in the industry expressing anger and frustration. Radiology leaders have called the proposals “arbitrary” and “unfounded,” and all agree the reductions will negatively impact practice management and patient care.

CMS this week released its proposed Medicare Physician Fee Schedule for 2013, calling for a 4 percent to 19 percent drop in radiology reimbursement rates. The proposal would also extend a contentious policy that governs imaging conducted by a single physician during one patient encounter.

“The most important thing to remember is these are the latest in a series of arbitrary cuts to radiology reimbursement that started with provisions back in 2006,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Commission on Economics and the ACR Board of Chancellors. “We’ve long argued that CMS has flawed data, and they continue to single out radiology based on the perception that imaging is a growing market with run-away costs. That’s simply not the case. Imaging and the associated spending levels are back to early 2000s levels.”

According to the proposed rule, many radiology services would see reimbursement levels drop: 19 percent in radiation therapy centers, 15 percent in radiation oncology, 8 percent in diagnostic testing facilities, and 4 percent in nuclear medicine. These cuts would be reallocated as 7 percent reimbursement increases to family medicine physicians and other primary care providers.

The quality of patient care, particularly in outpatient radiation therapy centers, could decrease if these proposed reimbursement cuts take effect as-is, McGinty said. Many of these centers would likely close their doors, limiting patient access to this type of high-quality, cost-effective care.

The industry’s strongest outcry, however, stems from a measure to expand the current 25 percent multiple procedure payment reduction (MPPR) on provider services for CT, MRI, and ultrasound. Currently, the MPPR applies to imaging services rendered by the same physician to the same patient during the same encounter. The new proposal would extend the MPPR to other physicians within the same group practice who performed subsequent procedures in those same patient encounters.

If this proposal becomes permanent, it will have a chilling effect of how providers work together, said Paul Ellenbogen, MD, FACR, chair of the ACR Board of Chancellors.“These cuts discourage doctors from working as a team and pull the rug out from under the very physicians working to save these people’s lives,” he said in a written statement.

There’s also a chance expanding the MPPR will have a significant, negative impact on work flow, said Mike Mabry, executive director of the Radiology Business Management Association. It’s unclear whether smaller or more rural radiology practices would be able to effectively and efficiently change their billing strategies.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/news/display/article/113619/2090032

July 13, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , | Leave a comment

   

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