ACR Economics Update: Radiology Payment and Reimbursement Speaker Name Title.

Slides:

Advertisements

Similar presentations

EMPOWERING PHYSICIANS TO DELIVER THE BEST PATIENT CARE Slides courtesy of: Richard W. Waguespack, MD, FACS President Elect, AAO-HNS, Former CPT Editorial.

Advertisements

AAMC Contacts: Ivy Baer, J.D., M.P.H. Sr. Director and Regulatory Counsel Evan Collins, M.H.A. Specialist, Clinical Operations and Policy.

Physician Payment Issues Implications for Obstetric Care James Scroggs Director Health Economics Department The American College of Obstetricians and Gynecologists.

2010 Changes – Physician Fee Schedule Billing & Reimbursement for Consultations December 16, 2009.

2010 Medicare Physician Fee Schedule What It Means for Cardiology.

CPT Review of Drug Administration Services AMA Presentation.

The RBRVS and the AMA/ Specialty Society RVS Update Committee (RUC) Process 2009.

Medicare RBRVS Medicare implemented the Resource-Based Relative Value Scale (RBRVS) on January 1, 1992 Standardized physician payment schedule where payments.

Reimbursement Seminar for Motion Analysis Laboratories

Coding Basics ASDIN Coding Committee 1 CPT Codes CPT stands for Current Procedural Terminology Current Procedural Terminology refers to a listing of.

The Treasure Hunt—Keys to Unlocking Radiology Reimbursement PAYMENT Walt Blackham, MS, RCC Radiology Business Management Association, RBMA.

ACR-RFS Overview A brief introduction to the American College of Radiology.

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. Reasons Radiologists Should Embrace Point Of Care Clinical Decision Support.

The EMR Puzzle – Putting the Pieces Together March 10, 2015.

Better, Smarter, Healthier Delivery System Reform Presentation to the Health IT Policy Committee March 10, 2015 U.S. Department of Health and Human Services.

Preparing for ICD-10 Implementation WV HFMA 2012 Revenue Cycle Spring Workshop.

Payment for Physicians’ Services Under Medicare Carol Bazell, M.D., M.P.H. Medical Officer Hospital and Ambulatory Policy Group Center for Medicare Management.

Colorado Title X Family Planning Program Cost Analysis/Rate Setting Part 2: Volume and Value.

Medical Assisting Chapter 16

Speaker Name Date Imaging 3.0: A Framework for Radiologists’ Future.

1 Reimbursing Health Care Providers It is all about striking the right balance between economic incentives for over-treatment and under- treatment Yaseen.

Behavioral Health Coding that Works in Primary Care Mary Jean Mork, LCSW April 16 & 17, 2009.

Understanding the RUC Survey 1. PURPOSE OF THE SURVEY Measure physician work involved in the new, surveyed procedure code by comparing the new procedure.

Understanding the RUC Survey Instrument November 2013.

SGR Formula Effect Prepared by: Lisa Patrick, MD Mount Sinai School of Medicine.

© 2006, UHC and AAMCPage 1 Jeff L. Good, MBA Program Director, FPSC Analytics and Quality Assurance Phone: The RBRVS.

© 2013 McKesson Specialty Health. All Rights ReservedFor internal use only/proprietary and confidential. CMS Releases 2014 Medicare Physician Fee Schedule.

Efforts to Sustain Asthma Home Visiting Interventions in Massachusetts Jean Zotter, JD Director, Office of Integrated Policy, Planning and Management and.

MedPAC’s rural Medicare payment recommendations and studies Jeffrey Stensland August 28, 2007 Opinions expressed today are my own and do not necessarily.

San Diego Long Term Care Integration Project Presentation to: LTCIP Planning Committee April 12, 2006.

Reducing Compliance Risk- Strategies for Medicare Consultation Billing 2010 AAHAM Keystone Educational Meeting February 18, 2010.

APA 2005 The New Psychological and Neuropsychological Testing Codes Antonio E. Puente American Psychological Association August, 20, 2005 Washington, D.C.

Incentives & Outcomes Committee Draft Recommendations Public Employer Health Purchasing Committee October 25, 2010.

Because your patients come first. Regulatory and Practice Management Services Daniel L. Johnson, CPC, CPC-H.

Specialty Practice Pathologist Patient cap.org v. # Advocacy Workshop for Engaged Pathologists Mike Giuliani, Senior Director, Legislation and Political.

Overview of Hospice Payment Reform For VNAA Roundtable Robert J. Simione Managing Principal Simione Healthcare Consultants HOSPICE.

Managed Care. In the broadest terms, Kongstvedt (1997) describes managed care as a system of healthcare delivery that tries to manage the cost of healthcare,

Medicare Payment Innovations: Perspective from Group Health Inland Northwest State of Reform Conference Karen Lewis Smith Executive Director, Government.

Better, Smarter, Healthier: Delivery System Reform U.S. Department of Health and Human Services 1.

AMA/Specialty Society Relative Value Scale Update Committee (RUC) Medicare Medical Home Demonstration Project Recommendations Julia Pillsbury, DO, FAAP,

The Renal Physicians Association. Who is The Renal Physicians Association? A national organization with the expertise and successful track record of pro-actively.

ACC Advocacy Promoting Quality, Protecting Patients.

HealthCarePolicy& Financing SB15-228: RateReview Schedule Wilson D. Pace, MD Review Panel Member Slides from HCPF – Comments and Views Solely Those of.

Adapting to Change in Health Care and the Role of Policy in Enabling Our Future.

Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes.

MA DSAC Collaboration Institute for Special and General Education Leaders Session 4: February 28, 2012 Action Planning.

Disease Pathway Management: Cancer Care Ontario’s Approach

Designing and Implementing a Multi-Payer Payment Reform Project The DIAMOND Initiative Gary Oftedahl, MD Chief Knowledge Officer Institute for Clinical.

Understanding the RUC Survey Instrument. © 2012 American Medical Association. All rights reserved. 2 Understanding the RUC Survey Survey basics Purpose.

ICD-10 Operational and Revenue Cycle Impacts Wendy Haas, MBA, RN Dell Services Healthcare Consulting.

MEDICAL Billing and Coding TEMBC Education Explicit Intentional Instruction.

Overview: APTA Perspectives Alternative Payment Methodology.

AMERICAN COLLEGE OF CHEST PHYSICIANS “Improving Patient Care Through Education” Survey Participation Is Integral to Your Success: AMA/Specialty Society.

Myelography Coding Update: Revealing the Consequences of Bundling M Morris(1), R Whiting(2), S Rothenberg(1), B Saboury(1), S Boateng(1), R Tu(2) (3) (1)University.

Click to begin. Click here for Bonus round OIG Issues Medicare & Medicaid General 100 Point 200 Points 300 Points 400 Points 500 Points 100 Point 200.

Resolving Challenges in Physician-Level Measurement David S. P. Hopkins, Ph.D. Pacific Business Group on Health Pay for Performance Summit February 28,

Katie Keysor Senior Director Economics & Health Policy

UHC, DMO, and AWP UHC REIMBURSEMENT POLICY

Understanding the RUC Survey Instrument

One Approach to Bundled Payments

Washington Update PACT Medical Device Group March 7, 2013 Mark Leahey

RVU Primer What are RVUs?

William B Schroedter, BS, RVT, RPhS, FSVU

Radiation Therapy Coding Changes

Washington Update PACT Medical Device Group March 7, 2013 Mark Leahey

Using clinical decision support to improve imaging appropriateness

OVERVIEW WHAT ARE CPT CODES AND HOW ARE THEY DEVELOPED?

Using clinical decision support to improve imaging appropriateness

2015 Medicare Payment Changes

Presentation transcript:

ACR Economics Update: Radiology Payment and Reimbursement Speaker Name Title

What’s Happening in Reimbursement? Optional: Embed video clip of Dr. Geraldine McGinty here

What’s Happening in Reimbursement?  The CMS and HHS agenda:  Drive reimbursement to primary care  Reduce unit reimbursement for imaging to manage utilization  Reduce overall spending  Respond to “outside” pressure (e.g., MedPAC)

ACR Coding and Nomenclature Committee  Works with CPT Editorial Panel to optimize payment and reimbursement for radiologists under Fee-for-Service.  The CPT Editorial Panel operates under the auspices of the AMA.  11 physician representatives  One representative from various industry groups  Radiology is NOT guaranteed a seat at the table.

CPT Editorial Panel  2014 cycle (completed in February 2013) –New Cat I codes – 27 –Deleted codes – 23 –Revised codes – 2 –New Cat III codes – 4 –Cat III code extensions – 1  26 new codes resulted from the mandate to bundle.

Unrelenting Pressure to Bundle  The vast majority of our committee work is due to the mandate to bundle component codes.  The ACR has fought long and hard against these bundling mandates. But bundling is today’s reality.  We must stay engaged to protect the best interests of the radiology community.

Relative Value Update Committee  CMS is focused on identifying “potentially mis- valued” services.  Numerous radiology codes have been targeted for bundling.  Result = sharp reductions in payments.

American Medical Association Specialty Society R Relative Value Scale U Update C Committee R Resource B Based R Relative V Value S Scale

Total RVU Practice Expense RVU (TC) + Work RVU (PC)

ACR Refine- ment Panel RUCCMS FINAL

Making RUC Recommendations  ACR works with specialty societies to prepare and submit work and PE recommendations.  Values approved at the RUC are not final.  CMS reviews and refines recommendations and publishes the final rule.

Well-Know Payment Reductions Practice Expense RVU (TC) + Work RVU (PC)

PPIS – phased in

The Future PACS Valuation RVU Validation Project SGR Fix (Merge A/B) Site Neutral Discussion IPAB

Alternatives to Fee-for-Service  ACR will continue to defend the fee-for-service (FFS) payment system  ACR will ensure radiology and radiologists are prepared for the future

Tools for Radiologists  Contract evaluation tool  Working on update to reflect payment reform initiatives  Capitation handbook  Developed by Managed Care Committee and RBMA Payer Relations Committee  Imaging 3.0 tools  Presentations, resources, case studies  Best practices guidelines on imaging clinical decision support systems  Guidance for regulators, payers, vendors, referring physicians, and radiology providers about CDS systems