Radiology Billing, Other Coding Under Scrutiny

CHICAGO — The Office of Inspector General will be looking more carefully at how all practices bill for radiology services. This issue is particularly important for rheumatology practices that provide in-office radiology services, Mark Painter said at a meeting of the American College of Rheumatology.

“Billing for radiology services has gone up significantly. OIG will be very carefully looking at your imaging services,” he said. “If you did not have an imaging machine, and now you do, that's going to be a flag.” He advises thoroughly documenting medical necessity in the chart for all imaging services they provide.

Mastering CPT coding guidelines can improve practice management. “You have to understand what the payers are doing,” said Mr. Painter, a medical coding and reimbursement consultant in Denver.

The federal government did not make a lot of changes in current procedural terminology coding this year because the coding is budget neutral, and those involved in making decisions about CPT codes are careful about adding new codes, Mr. Painter said. However, there have been changes in policy that are important to physicians, he said.

Mr. Painter said another concern for rheumatologists is the Tax Relief and Health Care Act of 2006. Although this program averted a 5% payout on the conversion factor, it is only temporary. The act did not put any policies in place that extend beyond 2007.

Rheumatologists should also be aware of recovery audit contractors, independent contractors who report to insurance companies about billing companies. Currently, only Florida, California, and New York permit these “bounty hunters” to peruse bills obtained from insurance carriers and to zero in on questionable billing.

“They are out looking for low-hanging fruit,” Mr. Painter noted about these contractors. “The place where rheumatology is most vulnerable is infusions.” He advised physicians to document what they are billing for and, when using infusions, to provide the lot numbers of the medications.

Congress also passed the multiple imaging reduction policy, a change in the final rule that was supposed to be phased in over a 3-year period, but is now frozen at a 25% reduction rate. Under this policy, Medicare reimburses 100% of the first radiology service, but reduces payment for the technical component of the second service by 25% on the same day. Though this act applies to both hospital and in-office imaging, rheumatologists with an in-office radiology service could see losses.

Mr. Painter also discussed pay-for-performance updates. He said that Congress and the Centers for Medicare and Medicaid Services (CMS) are very interested in moving payments toward evidence-based medicine.

Although CMS opened up pay for performance to the general medical community in 2006, little voluntary reporting took place. To improve this, the CMS is offering a 1.5% bonus to physicians who report on their Medicare patients. A 6-month trial program began July 1. Physicians who report on at least 80% of total visits qualify for the bonus.

The future of this program will depend on ongoing budgets. Congress has not yet set aside funding for 2008.

Both pay for performance and the Physician Quality Reporting Initiative rely on adequate data collection, said Mr. Painter. He said practices must move toward electronic health records to improve data collection for these initiatives. “Data are driving this,” he said.

CHICAGO — The Office of Inspector General will be looking more carefully at how all practices bill for radiology services. This issue is particularly important for rheumatology practices that provide in-office radiology services, Mark Painter said at a meeting of the American College of Rheumatology.

“Billing for radiology services has gone up significantly. OIG will be very carefully looking at your imaging services,” he said. “If you did not have an imaging machine, and now you do, that's going to be a flag.” He advises thoroughly documenting medical necessity in the chart for all imaging services they provide.

Mastering CPT coding guidelines can improve practice management. “You have to understand what the payers are doing,” said Mr. Painter, a medical coding and reimbursement consultant in Denver.

The federal government did not make a lot of changes in current procedural terminology coding this year because the coding is budget neutral, and those involved in making decisions about CPT codes are careful about adding new codes, Mr. Painter said. However, there have been changes in policy that are important to physicians, he said.

Mr. Painter said another concern for rheumatologists is the Tax Relief and Health Care Act of 2006. Although this program averted a 5% payout on the conversion factor, it is only temporary. The act did not put any policies in place that extend beyond 2007.

Rheumatologists should also be aware of recovery audit contractors, independent contractors who report to insurance companies about billing companies. Currently, only Florida, California, and New York permit these “bounty hunters” to peruse bills obtained from insurance carriers and to zero in on questionable billing.

“They are out looking for low-hanging fruit,” Mr. Painter noted about these contractors. “The place where rheumatology is most vulnerable is infusions.” He advised physicians to document what they are billing for and, when using infusions, to provide the lot numbers of the medications.

Congress also passed the multiple imaging reduction policy, a change in the final rule that was supposed to be phased in over a 3-year period, but is now frozen at a 25% reduction rate. Under this policy, Medicare reimburses 100% of the first radiology service, but reduces payment for the technical component of the second service by 25% on the same day. Though this act applies to both hospital and in-office imaging, rheumatologists with an in-office radiology service could see losses.

Mr. Painter also discussed pay-for-performance updates. He said that Congress and the Centers for Medicare and Medicaid Services (CMS) are very interested in moving payments toward evidence-based medicine.

Although CMS opened up pay for performance to the general medical community in 2006, little voluntary reporting took place. To improve this, the CMS is offering a 1.5% bonus to physicians who report on their Medicare patients. A 6-month trial program began July 1. Physicians who report on at least 80% of total visits qualify for the bonus.

The future of this program will depend on ongoing budgets. Congress has not yet set aside funding for 2008.

Both pay for performance and the Physician Quality Reporting Initiative rely on adequate data collection, said Mr. Painter. He said practices must move toward electronic health records to improve data collection for these initiatives. “Data are driving this,” he said.

CHICAGO — The Office of Inspector General will be looking more carefully at how all practices bill for radiology services. This issue is particularly important for rheumatology practices that provide in-office radiology services, Mark Painter said at a meeting of the American College of Rheumatology.

“Billing for radiology services has gone up significantly. OIG will be very carefully looking at your imaging services,” he said. “If you did not have an imaging machine, and now you do, that's going to be a flag.” He advises thoroughly documenting medical necessity in the chart for all imaging services they provide.

Mastering CPT coding guidelines can improve practice management. “You have to understand what the payers are doing,” said Mr. Painter, a medical coding and reimbursement consultant in Denver.

The federal government did not make a lot of changes in current procedural terminology coding this year because the coding is budget neutral, and those involved in making decisions about CPT codes are careful about adding new codes, Mr. Painter said. However, there have been changes in policy that are important to physicians, he said.

Mr. Painter said another concern for rheumatologists is the Tax Relief and Health Care Act of 2006. Although this program averted a 5% payout on the conversion factor, it is only temporary. The act did not put any policies in place that extend beyond 2007.

Rheumatologists should also be aware of recovery audit contractors, independent contractors who report to insurance companies about billing companies. Currently, only Florida, California, and New York permit these “bounty hunters” to peruse bills obtained from insurance carriers and to zero in on questionable billing.

“They are out looking for low-hanging fruit,” Mr. Painter noted about these contractors. “The place where rheumatology is most vulnerable is infusions.” He advised physicians to document what they are billing for and, when using infusions, to provide the lot numbers of the medications.

Congress also passed the multiple imaging reduction policy, a change in the final rule that was supposed to be phased in over a 3-year period, but is now frozen at a 25% reduction rate. Under this policy, Medicare reimburses 100% of the first radiology service, but reduces payment for the technical component of the second service by 25% on the same day. Though this act applies to both hospital and in-office imaging, rheumatologists with an in-office radiology service could see losses.

Mr. Painter also discussed pay-for-performance updates. He said that Congress and the Centers for Medicare and Medicaid Services (CMS) are very interested in moving payments toward evidence-based medicine.

Although CMS opened up pay for performance to the general medical community in 2006, little voluntary reporting took place. To improve this, the CMS is offering a 1.5% bonus to physicians who report on their Medicare patients. A 6-month trial program began July 1. Physicians who report on at least 80% of total visits qualify for the bonus.

The future of this program will depend on ongoing budgets. Congress has not yet set aside funding for 2008.

Both pay for performance and the Physician Quality Reporting Initiative rely on adequate data collection, said Mr. Painter. He said practices must move toward electronic health records to improve data collection for these initiatives. “Data are driving this,” he said.