2017 Bringing lots of changes in Radiology billing

March 08, 2017


Did you know that right from Jan 1, 2017 all providers still using film will have to suffer 20% reduction in reimbursements? So, what's the answer for those of us who are still clinging on to outdated technologies and not turning digital? Of course, most of the larger providers don't have to worry too much about their Radiology billing as they have almost completely stopped using film though smaller practices are still stuck with film and have to take the 20% hit and grin and bear it unless they are willing to update their equipment.

Radiology practices need to realize that they cannot afford to wait any longer though the financial constraints involved are quite understandable. Radiology billing & coding companies and practices using computed radiography beware that come 2018 there will be a 7% reduction that will come into force, and being forewarned is certainly being forearmed. That's not all, there will be additional reductions being added each successive year.

Radiology billing vendors should also make themselves aware that 2017 heralds some changes in mammography codes, courtesy the forthcoming 2017 Medicare Physician Fee Schedule (MPFS) that CMS came out with last July. We should be getting a better idea of things by this November. Radiology billing & coding service providers should realize that most of codes in use currently for reporting mammography and CAD will be soon outdated, with new codes bundling mammography and CAD replacing them (when both are performed), and the American College of Radiology (ACR)ruefully concurs that this time the CMS is indeed right.

The ACR is all praise for CMS, which has acknowledged the true worth of the radiologists who provide mammography services via the physician work relative value units (RVUs) as far as diagnostic mammography is concerned. The ACR is also glad that the CMS has confirmed that the radiologists are maintaining the current value for screening mammography. There is more reason to rejoice for radiologists and related Radiology coding services providers, thanks to the proposed rule which slashes the multiple procedure payment reduction from 25% to 5%, which is already effective (since Jan 1, 2017).

The Radiology Business Management Association (RBMA) along with the American College of Radiology has welcomed this move and the members of the RBMA have been educating the representatives about the effect such a large cut is going to have on the practices and Radiology billing providers too are aware of the direct consequences this payment reduction is going to make. However, most of the healthcare organizations are quite unfazed and are set to increase their budgets in the course of 2017 – 2018 which will certainly reflect in better patient-centered care that physicians will strive to achieve.

Although originally Jan 1, 2017 was the deadline set by the CMS for physicians to start upgrading their equipment and ordering exams that would be conducted using advanced imaging through clinical decision support (CDS) systems which will be based on specific criteria. Although most of the affected parties were OK with the deadline the CMS magnanimously extended the time limit for providers to beef up and adapt to the new stipulations.

However, the proposed 2017 Medicare Physician Fee Schedule has come up with a new deadline of Jan 1, 2018 and those keen on CDS will have ample time at their disposal, and those who still wish to cling to the old way of doing things have the liberty to continue till they feel it deem fit to upgrade before the deadline expires. Radiologists and imaging specialists have a lot to chew upon as do Radiology billing vendors who will be directly affected by the proposed payment reduction though they will certainly try to grin and bear it, having the welfare of the patients on their minds foremost.


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