Just because there is a procedure code for a service does not mean that it is accepted and/or reimbursed for all payers.
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CMS believes that the earliest that its claims processing system can begin screening claims using the AUC program claims processing edits for the payment penalty phase is October 2022.
In some practices there are situations that arise where the radiologists are asked to interpret images, aka “spot” images, in conjunction with other procedures, typically performed by other specialties.
Computed tomography (CT) and computed tomographic angiography (CTA) are imaging studies that continue to see increases in volumes and are targeted by the payers for medical necessity and coverage.
The proper use of ABNs is very important in radiology since many radiology claims are denied for medical necessity – specifically, the lack of a covered diagnosis.
Radiologists perform Evaluation and Management (E/M) services and may bill for them. However, it is important to distinguish between a separate E/M service, and the interaction with the patient that is related to and inherent in a procedure provided on the same date of service.
The guidelines for the ordering of diagnostic tests in the non-hospital setting have been around for 20 years.
Patient relationship categories and modifiers have been around for a number of years, but their utilization is not mandatory, and it is unclear when and if this will occur.
It is easy to focus on big dollar items when looking for potential lost revenue in an imaging center or department, but sometimes it is the little things that can add up to big money.
A good new year’s resolution is to ensure that all your current processes are compliant and reviewing orders is a great place to start.
