Pending changes to Medicare in the Deficit Reduction Act of 2005 call for nonhospital outpatient technical fee reimbursement to be the lesser amount of either the Hospital Outpatient Prospective Payment System (HOPPS) or the physician fee schedule.
Pending changes to Medicare in the Deficit Reduction Act of 2005 call for nonhospital outpatient technical fee reimbursement to be the lesser amount of either the Hospital Outpatient Prospective Payment System (HOPPS) or the physician fee schedule. The problem is these are two entirely different systems, and one methodology cannot be used as a payment mechanism for the other, according to Pam Kassing, senior director of the American College of Radiology department of economics and health policy.
The physician fee schedule, developed by the Centers for Medicare and Medicaid Services more than 20 years ago, is a resource-based relative value scale (RBRVS) for determining practice expenses. The three components of RBRVS are physician work, practice expense (direct and indirect), and malpractice. Each component is adjusted to reflect different costs for different geographic areas.
Under HOPPS, Medicare pays for hospital outpatient services on a rate-per-service basis that varies according to the ambulatory payment classification (APC) group to which the service is assigned. Each APC weight represents the median hospital cost of the services. Unlike the physician fee schedule, HOPPS and APC are not resource-based systems. They are more akin to accounting procedures, and their payment rates vary from hospital to hospital and even from cost center to cost center.
http://diagnosticimaging.com
A Victory for Radiology: New CMS Proposal Would Provide Coverage of CT Colonography in 2025
July 12th 2024In newly issued proposals addressing changes to coverage for Medicare services in 2025, the Centers for Medicare and Medicaid Services (CMS) announced its intent to provide coverage of computed tomography colonography (CTC) for Medicare beneficiaries in 2025.
The Reading Room: Artificial Intelligence: What RSNA 2020 Offered, and What 2021 Could Bring
December 5th 2020Nina Kottler, M.D., chief medical officer of AI at Radiology Partners, discusses, during RSNA 2020, what new developments the annual meeting provided about these technologies, sessions to access, and what to expect in the coming year.
ACR Collaborative Model Leads to 35 Percent Improvement with Mammography Positioning Criteria
July 1st 2024Noting significant variation with facilities for achieving passing criteria for mammography positioning, researchers found that structured interventions, ranging from weekly auditing of images taken by technologists to mechanisms for feedback from radiologists to technologists, led to significant improvements in a multicenter study.
New Study Shows Non-Radiologists Interpreting 28 Percent of Imaging for Medicare Patients
June 28th 2024While radiologists interpreted approximately 99 percent of all non-cardiac CT, MRI and nuclear medicine studies in hospital and emergency department settings for Medicare beneficiaries, new research shows significantly less radiologist review of cardiac imaging and office-based imaging.