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Radiology and Radiation Oncology Regulatory Changes for 2015

February 09, 2015

Medicare and Medicaid programs have received significant modifications under the Affordable Care Act. The act has also impacted the revenue pattern for various practices. The Centers for Medicaid and Medicare Services (CMS) announced the 2015 Physician Fee Schedule and it proposed payment changes for medical practices that include radiology.

This fee schedule also includes transparency in the development of payment rates, new updates for ambulance fee schedule regulations and implementation of separate payment procedures for chronic care management.

Impact on Radiology Billing Services

Radiologists and radiation oncologists will see reimbursement changes in 2015. These new regulations will have an impact on radiology billing services. The Medicare’s feasibility to reimburse radiologists under Physician Fee Schedule Proposed Rule (PFSP) is being considered by the CMS currently. This consideration is for reimbursing radiologists when additional interpretation of an existing image is requested.

As far as the practice expenses are concerned, CMS has suggested that radiation treatment vaults should be classified as indirect practice costs rather than direct charges. Numerous coding changes have also been introduced for radiology practices. In the upcoming 2015 PFSP, CMS has asked for deletion of mammography G-codes that are currently the only authorized method for billing radiology services using tomosynthesis.

The CMS has suggested that all mammography services be billed under established CPT codes. CMS has also challenged the current mammography CPT codes saying that they are mis-valued. A review has been requested for ensuring that some important factors are considered when setting the payment reimbursements such as, appropriate relative value units or accurate reflected direct practice expenses.

The 2015 has introduced maximum new rules, new changes and new codes for the radiology and radiation oncology practices. For instance, changes in CPT 2015 include vascular and non-vascular interventional radiology codes. Significant changes have also taken place in breast imaging and radiation therapy codes. It contains revised and new codes for various interventional, diagnostic, nuclear medicine and radiation oncology procedures. It has become important for providers to understand these changes in order to get timely payments.

Impact on Radiation Oncology

According to the Medicare Physician Fee Schedule (MPFS) of CY 2015, radiation oncologists will not see any changes in the total allowed charges. The new coding represents important changes in how radiation therapy services and the related image guidance are reported.

This year CMS will maintain the inputs for radiation therapy codes at 2014 levels. Oncologists will be able to use G-codes for continuing to report services for CPT codes that have been deleted. CMS has announced that it will delay the revaluation of new radiation oncology codes until CY 2016. This delay will allow CMS to issue revalued codes in the CY 2016 proposed rule.

Outsourcing Trend has Picked up Pace

To ensure a steady revenue cycle, many practices have opted to outsource radiology billing and radiation oncology billing. Practices have been choosing billing companies like MedicalBillersandCoders.com for error-free coding and getting timely payments. Companies like MBC have a team of skilled and certified coders and billers who can help radiologists and oncologists end their struggle with delayed or denied payments.


Category : ACA / HIPAA / Reforms