Radiology Assistants Seek CMS Recognition

April 9, 2013

Midlevel providers can help meet growing patient demand while controlling costs. Now, radiologist assistants are seeking appropriate reimbursement.

Across healthcare, midlevel providers continue to solidify their importance in meeting growing patient demand while controlling costs. Now, radiologist assistants are seeking recognition from the federal government.

The issue is one of money and billing, but the repercussions go to the greater need to meet increased patient needs as the Medicare roles swell. Currently, radiologist assistants are not recognized within the CMS billing codes. Instead, their services can only be billed as technologists.

For five years, radiologist assistants have sought a separate and unique CMS designation as midlevel providers licensed as Radiology Practitioner Assistants and Registered Radiologist Assistants. As it stands CMS only has billing codes for technologists and physicians in the field of radiology.

After several years of conversations with CMS, it became clear that to recognize RAs as non-physician providers, Congress would have to amend the Social Security Act, said Jason Barrett, a duly licensed RPA and RRA in Montana and the president of the Society of Radiology Physician Extenders, who has been among the leaders advocating for the recognition.

The process is similar to what has already happened to recognized midlevel providers like physician assistants and nurse practitioners.

Last month, the Medicare Access to Radiology Care Act of 2013 was introduced in the House, marking the second attempt to legislate the change.

When the same bill was introduced during the 112th Congress it garnered bipartisan support from 41 cosponsors, but failed to gain traction. Proponents of the bill suggested that the stalemated Congress on highly contentious fiscal issues left little chance for their bill to see the light of day.

"It was a victim of the political circumstances surrounding the election and Congress last year," said Chris Sherin, director of congressional affairs for the American College of Radiology, noting that the bill had, and continues to have, wide support among radiology groups.

This time, the aim is for the bill to be attached to a larger healthcare or Medicare bill, such as the sustainable growth rate deal that will likely be taken up in the summer, Barrett said.

RAs are trained radiographers who have worked in the field for at least three years before returning to school for an additional two years in a master's level program. About 550 RAs are licensed in the United States, said Jerry Reid, executive director of The American Registry of Radiologic Technologists, the credentialing body for technologists and one of the groups actively involved in seeking the recognition for RAs.

Twenty-nine states have established licensing procedures for recognizing radiology assistants as midlevel providers who work under the supervision of radiologists but have autonomy to preform certain imaging services and procedures that would otherwise be done by a licensed physician, Reid said.

While he couldn't provide growth estimates for the RA field, Reid said fixing the billing issues with CMS would allow the profession to grow and likely spur more states to establish RA licensing.

Embracing RAs is vital if radiology practices are going to meet the demand of Medicare patients in need of interventional radiology, diagnostic imaging and other radiologic services, advocates said.

While RAs cannot provide diagnoses, prescribe medication or therapies, or interpret medical images, they can perform select procedures, and conduct patient assessment and management. But unlike a technologist, RAs can perform procedures that are typically done by a radiologist, with the technologist assisting the RA. Already, private payers have recognized the value of RAs, agreeing to pay for some basic procedures, including several routine GI procedures, fluoroscopy and joint injections, among a host of other things.

The problem is CMS has never distinguished between a radiology technologists and a radiology assistant, Barrett said.

"So all of us have the same supervision codes," he said. "It means that the radiologist has to be in the room at the quote critical time of the procedure."

Yet, RAs are trained to do those procedures without their supervising physician in the room. Being in the room is unnecessary and a waste of valuable time, said Ben Pomerantz, MD, a radiologist for the Northwest Imaging PC practice in Montana that employs Barrett.

"In my experience, the RA operates above the level of a radiologist fellow," Pomerantz said. "They are very skilled and knowledgeable and they operate at an incredibly high level."

The bill would change the supervisory requirement from personal, or in the room, to direct, where the physician is on site but not in the room, Reid said.

With Medicare recipients making up more than half of his practice's patient volume, Pomerantz said making the change is critical to ensuring an efficient practice that can care for all patients appropriately and timely.

"Employing RAs really increases our efficiency," he said. "IR and radiology in general is growing as people want to have procedures done and non-invasive imaging studies done. A lot of the procedures are relatively routine and we need to be able to handle the increase in volume."

Plus, having RAs on hand allows him and the other radiologists in the practice more time to spend on complex cases or in the reading room, Pomerantz said.

"They are more of our colleagues than anything else," he said. "We work side by side to provide a sort of a synergistic care. It is better care for our patients in a timely fashion and we can save money."

Under the bill, worked done by radiology assistants would continued to be billed to CMS by their supervising physicians, but would be billed at a reduced rate of 85 percent of cost of the fee schedule for a radiologist to perform the same procedure.

The bill, HR 1148, has been referred to the Committee on Energy and Commerce, and the Committee on Ways and Means. No senate companion bill has been submitted, although Barrett said they are actively seeking sponsorship on the Senate side.