Few challenges are as great as balancing the delivery of medicine with the business of healthcare and staying abreast of all the changes in diagnostic radiology revenue cycle management.

It takes a uniquely qualified diagnostic radiology medical coding, billing and collections expert to keep physicians continually updated and their revenue streaming in these choppy, uncertain reimbursement waters, especially when they pertain to Medicare.

This just in…the final CMS rules are out.

The Centers for Medicare & Medicaid Services (CMS) has revised the payment system for Medicare services, which coincides with the implementation of new CPT codes.

According to a January 2013 edition of Radiology Today magazine article “…while the published changes will have a minimal impact on hospital payments for diagnostic radiology services, they will have a significant impact on physician payments for the same services.

“Fortunately, for hospital billing, the CMS has not created any new composite APs such as the advanced imaging composite currently in place. Unfortunately, for physician billing, the CMS has created two new families of codes that are subject to multiple procedure discounting that will reduce physician payment.”

Examples of some of the many changes listed in Radiology Today include:

    • Medicare Payment to Physicians
      This year, cardiovascular and ophthalmology procedures will be subject to multiple-procedure discounting of the physician technical component payment; the professional component will not be subject to discounting. This change in payment impacts procedures performed in a physician’s office, not in the hospital setting. The cardiovascular family includes services such as angiography radiological supervision and interpretation codes, noninvasive vascular procedure codes, cardiovascular nuclear medicine procedures, and cardiac catheterization. The ophthalmology family includes services such as ultrasound procedures of the eyes.

      The most significant impact to physician billing of radiology services is the new cardiovascular family. When one or more procedures from this family are performed, the technical component of the first procedure will be reimbursed at 100%, and the technical component of each additional procedure in the family will be reimbursed at 75% of the physician fee schedule. When a physician bills for a global service (professional and technical component together),the technical component of the global payment will be subject to the discounting formula for these procedures.

      One other change for this year is the discounting of several medicine procedures. Procedure codes 78802, 78803, 78806, and 78807 have been subject to the -51 modifier (multiple-procedure discounting) for a long time. This year, however, code 78306 (whole-body bone scan) will be discounted 50% when reported with 78320 (bone SPECT).

    • Changes in Medicare Payment to Hospitals
      There are significant changes in the Hospital Outpatient Prospective Payment System (HOPPS), the majority affecting cardiac catheterization and electrophysiology procedures.
    • CPT Code Changes
      Separate from the annual changes in Medicare payments, the CPT Code Book also is updated annually. This year, though, there were few changes for reporting CPT codes for diagnostic radiology procedures.
      With all these changes, the experience with your medical coding, billing and collections team can be the difference between profit and loss. It’s that simple.

An industry insider like revMD.com has the industry experience that only comes from responding to the specific diagnostic radiology revenue cycle management needs for many years.

revMD.com is the results-proven alternative for healthcare revenue cycle management, with a niche specialization in diagnostic radiology medical coding and billing that generates unprecedented results and builds profitable medical practices. Leveraging a history of industry wide success spanning 25 years, revMD.com partners with medical practices in Arizona and throughout the U.S. to optimize revenue for hospital based and practice based physicians. For more information, visit www.revmd.com.
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