Imaging Center Billing

Telehealth Benefits Temporarily Expanded

The White House has announced that beginning on March 6, Medicare administered by CMS will temporarily pay clinicians to providing virtual visits and other telehealth services to beneficiaries.

Anthem CT Posts Advanced Imaging Clinical Appropriateness Guideline Updates

Anthem Blue Cross and Blue Shield (Anthem) of Connecticut (CT) released certain updates to its Vascular Imaging Clinical Appropriateness Guidelines which includes new and updated language for indication of asymptomatic enlargement by imaging and clarifying surveillance intervals for stable aneurysms.

UnitedHealthcare Implements Enhancements to Procedure to Modifier Policy

UnitedHealthcare has announced plans to implement certain changes to enhance the Procedure to Modifier Policy for Medicare Advantage plans to include modifiers CT, FX and FY.

UHC Radiology Program Procedure Code Changes

Effective January 1, UnitedHealthcare (UHC) will update the procedure code list for the Radiology Notification and Prior Authorization programs based on code changes made by the American Medical Association (AMA). Claims with dates of service on or after January 1 are subject to these changes.

Year-End Spending Bills Include Millions toward Key Radiology Research Efforts

The year-end spending bill package signed, last month, by the president will provide billions in funding toward research that’s key to radiologists’ work. The legislation allocates $41.7 billion to the National Institutes of Health (NIH) and also provides $338 million to the Agency for Healthcare Research and Quality to support NIH research initiatives.

CMS, HHS Proposes Changes to Stark Law and Anti-Kickback Statute Reforms

On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.

CMS Advances ‘Patients over Paperwork’ Initiative Under Final Rule

On September 26, CMS issued The Omnibus Burden Reduction (Conditions of Participation) Final Rule, which advances the ‘Patients over Paperwork’ initiative aimed at reducing administrative costs in healthcare.

Texas to Receive Increase in Federal Funds for Uncompensated Care

The Texas Health and Human Services Commission announced, on October 1, that the state will be given $11.6 billion over the next three years to help reimburse health care providers for indigent services and is intended to benefit hospitals, clinics, public ambulance, and dental providers.

House Ways and Means Committee Chairman Proposes New Approach to End Surprise Medical Bills

In a letter to the House Ways and Means Committee, Chairman Richard Neal has proposed that the Departments of Health and Human Services (HHS), the U.S. Labor and Treasury Department, along with other interested parties, consolidate their efforts to develop standards for rates for surprise bills.

Proposed Legislation Aims to Improve Provider Directories Accuracy

Two physician lawmakers have proposed new legislation that aims to improve the accuracy of information in health plan provider directories and protect patients from surprise out-of-network bills. The Improving Provider Directories Act (HR 4575) would require health plans to provide an avenue for people to report errors in provider directories, in a “highly visible way”.

Executive Order Issued to Protect Traditional Medicare and MA Plans

The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.

Aetna Wisconsin Issues New Preapproval Requirements for Members

Effective July 1, Aetna will require prior authorization for certain procedures under its Enhanced Clinical Review Program with eviCore healthcare.

Cigna Clinical, Reimbursement, and Administrative Policy Updates

Cigna has published a number of clinical, reimbursement, and administrative policy updates, including its reimbursement policy for spinal fusion related services, venous angioplasty, and orthotic prescriptions.

Aetna Issues New Radiation Therapy Preapproval Requirements

Beginning July 1, Aetna will require authorization for its enhanced clinical review program with eviCore healthcare for certain outpatient radiation therapy services.

CMS Issues Renewed Guidance to Ensure Medicaid Program Integrity

On June 20, CMS released a renewed guidance to state Medicaid agencies that outlines the necessary assurances that states should make to ensure that program resources are reserved for those who meet eligibility requirements.

CMS Releases 2018 ACA Risk-Adjustment Data

CMS, on June 28, released its report summary of the Affordable Care Act (ACA) risk adjustment program for the 2018 benefit year. The analysis found that 572 health insurers offering ACA plans participated in the program in 2018, and transfers between the companies totaled $10.4 billion.