By Melody W. Mulaik, MSHS, CRA, FAHRA, RCC, CPC, CPC-H
Both the House of Representatives and the Senate have passed the Protecting Access to Medicare Act of 2014, which will provide a 12-month “patch” to the SGR, preventing a 24% reduction in Medicare physician reimbursement. The act will also further delay ICD-10 compliance to October 1, 2015.
Also included in this bill are several other provisions that will affect imaging providers. For AHRA members the key initiatives in this legislation are contained in Section 218: Quality incentives for CT diagnostic imaging and promoting evidence-based care.
First, it appears that this section is going to require CT equipment to meet certain technical standards or be subject to a payment reduction. In 2016 it will be a 5% reduction and in 2017 and beyond it will be a 15% reduction in payments. Suppliers and outpatient departments of hospitals will be required to attest to whether services furnished meet the technical standard. The suggestion is by use of a modifier which would then be verified by periodic accreditation or surveys that are required of these providers. This will include free-standing imaging centers as well as hospital imaging departments.
Also in this section is a requirement to establish a program to promote appropriate use criteria for “advanced diagnostic imaging service” in the physician office, hospital outpatient department (including ER), ambulatory surgical center, and any other “provider-led” outpatient setting. In addition to defining the ordering and furnishing providers, this part requires rulemaking to be published by November 15, 2015. It states that by January 1, 2017, all ordering professionals shall consult with a qualified decision support mechanism and provide specific information to the furnishing provider which must then be included on the claim. It also requires the identification of ‘outlier ordering professionals’ who will then be required to obtain prior authorizations for their services by January 1, 2020.
The act is currently pending President Obama’s signature. More information will be provided in the near future.
Melody W. Mulaik, MSHS, CRA, FAHRA, RCC, CPC, CPC-H is the president of Coding Strategies, Inc. and a member of the AHRA 2013-2014 Board of Directors. She can be reached at firstname.lastname@example.org.