Federal Regulations and Radiology
Published on the June 11, 2015 DiagnosticImaging.com website
By Whitney L.J. Howell
Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed.
Few things can impact radiology as directly or significantly as changes to health care regulations and policies. They’re initiatives that require you to change your workflow, to adopt new strategies, and even abandon long-used systems.
From the Affordable Care Act to coding overhauls to new value-based payment systems, industry experts are watching the next set of regulatory efforts to determine the impact on your daily practice.
“In many cases, you take the approach of preparing for the worst and hoping for the best,” said Tom Dickerson, MD, chief executive officer of Illinois-based Clinical Radiologists, SC.
The coming changes will build upon an uneven playing field for radiologists and the patients who need imaging services.
Despite long-standing fears that radiology volumes were lagging, the past four years have actually seen a nationwide bump of 8%. According to Sarah Mountford, client services manager with billing services company Zotec Partners, this boost can be attributed to the expansion of Medicaid services in some states, as well as the growth of health information exchanges and a recovering economy.
In fact, thanks to the Medicaid expansion, the percentage of uninsured patients using radiology services dropped from 7.5% to 6.5% between 2012 and 2014, respectively. On the flipside, states that didn’t expand Medicaid are seeing increases in uninsured patients accessing imaging services. That’s an uptick from 9% in 2012 to 12% in 2014 – more than 4 million patients.
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/federal-regulations-and-radiology
New CT Abdomen/Pelvis CPT Code Changes Cut Reimbursement
Published in the April 26, 2011, DiagnosticImaging.com
By Whitney L.J. Howell
As of Jan. 1, 2011, the Centers for Medicare & Medicaid Services (CMS) changed the way you code for abdomen and pelvis CT scans performed together. The new combined-code requirement slices reimbursement for these services in half.
Each time you run these scans together, for the same reason and on the same service date, you lose between $200-400 in reimbursement, depending upon whether the test requires a contrast agent. That’s a 50 percent payment reduction each time you scan for tumors, cancer or other such problems.
Although the original codes for abdomen and pelvis CT scans conducted separately still exist, CMS now mandates that services performed together at least 75 percent of the time must use one CPT code. Assigning one code in these instances is the agency’s way of eliminating what it considers double payments for similar scans conducted at the same time.
The American College of Radiology (ACR) has opposed the move for the past five years, citing concerns over lost reimbursement, potential confusion over using new codes correctly, and frustration that consideration wasn’t given to the physician time needed to read scans.
To read the remainder of the article online: http://www.diagnosticimaging.com/practice-management/content/article/113619/1850806
Who am I?
I’m a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree in international print journalism from The American University in Washington, D.C.
I launched my journalism career as a stringer for UPI on Sept. 11, 2001, on Capitol Hill. That day led to a two-year stint as a daily political reporter in Montgomery County, Md. As a staff writer for the Association of American Medical Colleges, a public relations specialist for the Duke University Medical Center and the public relations director for the UNC-Chapel Hill School of Nursing, I’ve earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.
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